Note (May 2014): While the environmental strategies and empirical knowledge outlined here have not changed, over time my understanding of this issue has evolved. (Read more news on the SolveEczema blog.) The most up-to-date overviewof the information can be found in the slideshow video linked to from the home page of this site. My apologies, it's a simple effort - I am not a media person - runs about 45 minutes and has only about 6 slides. It was created for my crowdfunding effort a few years ago to jumpstart efforts to write a book. I will be updating the website when the book is finished. I am also trying to write about the site more technically from the standpoint of "open source" medicine. Until then, watching the slideshow is useful for understanding the website before reading it.

GENERAL DISCUSSION:

ECZEMA OUTBREAKS ARE NOT RANDOM.

Eczema outbreaks are not random. They follow
logical rules. The problem can be solved, so long as one is able to
discern those rules.

One or more of the common substances in your home and outdoor
environments that you or your child is touching, eating, and possibly
inhaling, is causing the eczema and you can track it down.

Through this approach, we were able to completely eliminate our son’s
breakouts without steroids or any other medication.

Please remember that I am not a doctor or health care professional. I
am just another parent trying to share what helped us track down the
cause of our son’s eczema. Please read my disclaimer,
use your judgment, respect your individual sensitivities, and consult
your own doctor as often as necessary.

Why I didn’t just wait for my child to outgrow the
eczema.

My infant son’s eczema was so severe, it began affecting his
development. He couldn’t sleep, his mood, personality, and behavior
changed. The broken skin became infected easily. To my husband and me,
finding the cause was a matter of urgency.

Although doing the detective work and eliminating the cause from our
home has required a lot of work, NOT eliminating the eczema seemed far
more labor intensive and detrimental. The unpredictable and often
serious medical, social, personal, and emotional aspects of dealing
with such severe, ongoing eczema were, to us, far more time- and
energy-consuming.

In his book Touchpoints, Dr. T. Berry Brazelton writes about the
emotional consequences: “Avoiding frightening outbreaks of asthma or
eczema is very important to the future well-being of a child…. Once an
allergy is set in motion, and if a treatment that works is not found,
children feel increasing anxiety and helplessness.”

It made such a huge difference emotionally to all of us to find the key
that made the outbreaks predictable and allowed us to clear our son’s
skin completely.

After a long discussion with our pediatrician and a pediatric
nutritionist, as well as additional reading, I also felt that even
if my son did “grow out of it,” my efforts to eliminate the cause of
the eczema might mitigate future asthma symptoms.

It seemed that there was no reason to believe the eczema would likely
go away on its own anyway.

“Scientists estimate that 65 percent of patients develop eczema skin
symptoms in the first year of life, and 90 percent develop eczema
symptoms before the age of 5.

Roughly 60 percent of these infants continue to have one or more
symptoms of atopic dermatitis into adulthood. This means that more than
15 million people in the United States have symptoms of the disease.

Many children who outgrow the symptoms of eczema go on to develop hay
fever or asthma.”

Eczema and asthma cases have soared in recent years, and no one really
knows why. In our modern world, we are exposed to thousands of new
substances that didn’t exist at all 20, 50, 100 years ago. My son
wouldn’t have had eczema 90 years ago, because synthetic detergents
didn’t exist on the planet. Their use has skyrocketed since the ‘70s
especially.

So, when people ask if I think my son will outgrow his allergy, I have
to answer that there is no basis to know, because the presence of such
high levels of detergents on our persons and in home environments is so
new. The same is probably true for other allergens like latex. I read
recently in Science News that two common plasticizers, the
residues of which are commonly found in household dust in western
countries, have been linked to allergy and asthma. These weren’t nearly
so common 30 years ago, if they had been invented at all.

Over time, it has also become clear that the reaction is not a simple allergic reaction or irritation, and that the environmental changes we made to help our son also helped everyone in the household, and helps in other beneficial ways we didn't expect.

Past experience as to whether children will outgrow eczema is probably
misleading. My guess is that as eczema rates continue to rise, the
percentage of children that continue to have symptoms into adulthood
(the percentage that don’t outgrow it) will also rise. Studies looking at whether breastfeeding is preventative for allergies and eczema, for example, are now concluding that breastfeeding doesn't prevent alleryg and eczemy, as if the previous studies showing that breastfeeding did help were wrong. I think it's more likely both current and previous studies reflect accurately the existing environmental conditions of the time.

Maintaining our son’s clear skin has been less work than removing
detergent sources at the start.

Healthy Skin, Unhealthy Environmental
Exposures

A great deal of research and publication have gone into the subject of
finding a defect in the skin of eczema patients, ostensibly to find
treatments. One such line of inquiry concerned whether persons with
eczema have ceramide deficiency. Ceramides “represent the major
constituent of the free extractable intercellular lipids and play a
significant role in maintaining and structuring the water permeability
barrier of the skin.” [Farwanah H, Raith K, Neubert RH, Wohlrab J., Ceramide
profiles of the uninvolved skin in atopic dermatitis and psoriasis are
comparable to those of healthy skin,Arch Dermatol Res.
2005 May;296(11):514-521.]

The above researchers found that if they looked at the ceramide
profiles of both "lesional involved" as well as the “normal-appearing
uninvolved” skin, the uninvolved skin was just like healthy normal
skin. There are other similar lines of inquiry in the literature,
which in my opinion point more strongly to an environmental cause of
virtually all eczema than anything else, i.e., the eczema results from
something AFFECTING the skin rather than something ABOUT the skin.

Certainly, skin type is an issue — some people seem more susceptible to
the effects of detergents and other causes of eczema. Since genes
determine skin type, it would be possible to make genetic correlations.
But in that case, correlation does not mean causality. If skin type
makes one more susceptible to eczema from products that were only
invented in the last century, that in my opinion is a failing in the
design of these products that are not safe for all skin types, not a
defect in people with more affected skin types.

Eczema breakouts can seem maddeningly random. It would have been very
easy for us to believe that the solution would never be obvious,
obscured by the complexity of the human body or the mystery of some
complicated genetic defect.

At least I could quickly see that trying this and trying that, thinking
the cause was too elusive to track down, was leading more to
frustration than solutions.

That has also been the case for other parents I have tried to help. The
least successful haven’t put in any less work — in fact, often they put
in more — but the efforts were unfocused, as if somehow solving such a
problem is a game of chance rather than a mystery to solve by logical
steps and persistence. It is easy for even very educated people to
begin behaving in an almost superstitious manner, trying this product
and that product, and avoiding all the unknown and unseen exposures in
a random and desperate way.

I see over and over again how parents solve their children's eczema —
from this and other causes — when they accept that the problem isn't
random, and that the breakouts really are directly related to concrete
and proportional exposures. Figuring out what those are is of course
the difficult part, because of how complicated the environmental
exposures can be. Detergents in dust (which can adhere to the skin),
for example, cause a whole set of unseen exposures, complicated by the
nonlinear effect in the presence of small amounts of water (such as
sweating).

Not Everything That Affects Eczema is a True Cause

It is easy, too, to become a slave to addressing the “triggers” rather
than getting to the true cause. Dryness, for example, is often called
both a “cause” and a “trigger” for eczema. The CAUSE of our son’s
eczema was detergent, dryness was a trigger. Every winter, when the
heat comes on and dries out the air, our son’s skin becomes more
susceptible to breakouts from lower levels of detergent exposure. But
absent the detergents, his skin can be very dry with no eczema. With
detergent exposure, we can moisturize our hearts out, and it might
help, but we have to keep at it and keep at it, and still it won’t make
the eczema go away.

Exposure to pollen has worked the same way. When our son is exposed to
oak tree pollen — which gives him the usual respiratory symptoms — he
then breaks out from lower levels of detergent exposure. But absent any
detergent exposure, the pollens don’t seem to cause him eczema.

The same is true with mold exposure. According to the World Health Organization, "atopic and allergic people are particularly susceptible to biological and chemical agents in damp indoor environments" where molds especially are abundant. (See the WHO Guidelines for Indoor Air Quality - Dampness and Mould) We have seen our son's eczema completely resolve until he spends time in moldier indoor environments, where he becomes more susceptible to outbreaks from contact, and the typical areas of eczema that he gets from ingestion sources sprout up — and go away if we are laboriously fastidious about the detergents, or just get away from that environment and those exposures.

I have heard a good analogy for allergy as a bucket — exposure to
different things we are allergic to fills the bucket. We experience
symptoms when the bucket is filled to overflowing. If the bucket is
always close to overflowing because of a lot of exposure to one
allergen, then even small exposures to that allergen or to other things
we might otherwise tolerate cause the bucket to overflow. But if we are
able to keep the bucket relatively empty by avoiding enough of the
thing or things to which we are most allergic, then we may be able to
tolerate occasional exposures without problems.

In the above analogy, the presence of triggers might make it easier to
overflow a full bucket, but removing the triggers doesn’t help us empty
the bucket like removing the cause(s) does. In my experience, having a lot of detergent in the environment is like filling the bucket most of the way with bricks! Removing the bricks won't necessarily mean you can't overflow the bucket, especially if you don't remove all the bricks (the hardest ones at the bottom of things), or especially if there is a lot of mold or pollen in the environment. (I theorize that alerting us to a personally unhealthy level of mold or pollen in our environments is the whole evolutionary purpose of allergy, as allergens are similar to pathogens to the immune system. Detergents themselves are not the allergen, they make it possible for allergens to cross our membranes more easily and make it seem to our immune systems as if there is far more around us.)

In his book Touchpoints, Dr. T. Berry Brazelton recommends a
preventive approach. “Once an allergic symptom is out in the open, it
is harder to get rid of. At that point, we must eliminate not only the
immediate cause but also the milder offenders. If a parent is willing
and able to do this, the child may be able to tolerate the more potent
stimulus from time to time. So, with a child who gets hay fever with
each cold, or eczema every time he eats wheat, or asthma every time he
is upset, a preventive approach will seek to eliminate all of the
allergens he lives with, even though he can live with them most of the
time.”

As I point out in my letter, the advice
in Touchpoints helped us figure out the cause of our son’s
eczema. The chapter on Allergies is worth reading: while the
chapter is fairly compact, the advice and perspective are unique among
parenting books and consistent with my own experience with allergy. I
recommend reading through the chapter two or three times to start, and
again as necessary. The general allergy prevention approach will help
some to “empty the bucket” to allow a more clear stage to track down
any unidentified major offender. Brazelton recommends a list of general
allergy control measures in this chapter.

I would note, too, that detergents are very often the underlying reason for dry skin in people who don't get eczema, especially adults. I have heard from many people over the years who have resolved lifelong dry skin problems with these strategies. I see eczema as a signal that is triggered as a result of environmental/immunological conditions. A hundred years ago, that signal was rare and helpful (I'll discuss this in more detail in my book). Now the signal is being triggered and amplified under unnatural conditions.

The Detergent Piece of the Puzzle

In the course of trying to figure out why our son has this reaction to
detergents, I have come to believe that the problem has to do with skin
membrane permeability.

Detergents increase skin membrane permeability in a way that soaps and
water do not. This type of eczema — which I believe is probably 25-80%
of the eczema problem, depending on the age group — seems purely to
result from how detergents increase the permeability of skin. The
behavior of the eczema is entirely consistent with that premise.

When my son and other children like him are not exposed to detergents
at home, their skin becomes normal and isn’t especially dry. There is
no need even to moisturize.

Regarding membrane permeability, a microbiologist explained the
difference between soaps and detergents like this:

Humans have made soaps for thousands of years, by reacting fats or oils
with alkaline substances, such as ashes or soda ash. Synthetic
detergents — which can be synthesized from many different kinds of
starting ingredients, but were initially developed from petroleum —
were invented in the 20th century. Soaps and detergents are long
molecules which are attracted to oils on one end and water on the
other. Among other differences, detergents are far more hydrophilic
(water-attracting) than soaps. Detergent residues also seem to be far
more persistent in fabrics and tissues.

Humans evolved with the natural fatty acid profile of skin that best
repels water while maintaining necessary functions, such as
perspiration. Both soaps and detergents remove lipids that help
maintain that barrier.

When we use soap, even if residues remain on the skin, we are swapping
the skin lipids with something that has essentially the same hydration
properties. But the hydrophilic
end of virtually all modern detergentis far, far more hydrophilic than the water-loving end of soap
molecules. There can even be more than one hydrophilic branch on that
end of a detergent molecule. The natural barrier to water penetration
(and loss) is lost as these highly hydrophilic molecules build up on
the surface. We need that barrier to maintain the integrity of the skin. (For more on this, refer to my blog posts about dry skin.)

In my experience, the effect of detergents on membrane permeability is
nonlinear — it goes up exponentially in the presence of small amounts
of water (where there is sweating or in the moist environment of the
lungs). So someone may touch or be exposed to detergents and seem fine
until they sweat, and then the skin will break out, especially in the
moist areas. Much of the seeming randomness of eczema affected by
detergents comes about because of the unseen exposures from household
dust, how they adhere to and are absorbed in the skin, and the
nonlinear effect of detergents on skin membrane permeability in the
presence of small amounts of water.

An interesting side note: modern high-tech fabrics for outdoor clothing
and gear specify washing in soap, not detergents, because detergents
destroy the water repellency. From the Nikwax web site www.nikwax-usa.com:

“All detergents work in basically the same way. They contain
molecules that enable them to be soluble in water and attract oil and
dirt to them. These molecules clean by attracting themselves to dirt
via the oleophilic (oil attracting) end. The dirt is thereby surrounded
by hydrophilic (water attracting) ends which allow it to be wetted and
carried away by water. Detergents molecules can remain in clothing
causing them to attract water and diminish the water repellent
properties of the garment. Nikwax Tech-Wash is a non-detergent soap
that does not leave a residue and actually removes the detergent
residues from garments that have been washed in them.” (Nikwax
makes a soap product for washing outdoor gear that may be appropriate
for general clothes washing. I have not tried it. Please see the last
section for a list of different soap products.)

The effect of detergent residues on the skin membrane is analogous to
what happens to these water repellant fabrics.

There is a substantial body of relevant research in fields like patch
test dermatology and ophthalmology outlining these effects. For
example, in 2005, some ophthalmological researchers published a paper
about their attempts to develop a better skin test for substances used
in the eye. The eyes are more sensitive than the skin and more prone to
bad reactions. These researchers wanted to be able to predict allergic
reactions of the eye with skin testing — to essentially amplify the
skin response. They accomplished this with sodium lauryl sulfate,
the most common household detergent, which "increased antigen
penetration." [Corazza M ,Virgili A, Allergic contact
dermatitis from ophthalmic products: can pre-treatment with sodium
lauryl sulfate increase patch test sensitivity?Contact
Dermatitis 2005 May;52(5):239-41.]

The Atopic March — Asthmatics May Benefit From
Switching to Soaps

Because of the increased antigen penetration associated with
detergents, the way they pervade household dust, and the longer time
required to clear those exposures from the lungs, there is almost no
way that detergents in the dust of people's homes ISN'T a primary
reason for the upswing in asthma rates in recent decades.

It was very clear to us that detergents make up a great part of
household dust (from residues on hair, lint, skin cells, etc., even
flaking from washed surfaces), and that dust is impossible to keep from
affecting the skin.

Switching to soaps may be helpful for all children with allergies and
asthma, even those with no eczema. Detergents are breathed in with
household dust, and their presence in lung tissue increases
susceptibility of those tissues to allergens that may be causing the
asthma. Detergents have been shown to increase membrane healing time,
which may also have an impact especially where viruses are associated
with asthma. Because the detergent effect on membrane permeability is
exponentially greater in the presence of small amounts of water, the
unseen effect on the lungs could be significantly greater than the
visible effect on the skin.

I hear over and over again from people who "outgrow" eczema only to
develop asthma. It’s called the “atopic march” — first eczema, then
asthma.

With detergent-reactive eczema, it’s a logical progression from ongoing
detergent exposure. Babies have highly permeable skin and spend a good
deal of time with their skin against fabrics or a parent's skin or
hair. As children get older, they spend less time lying down or
crawling across surfaces. Their skin becomes naturally less permeable,
absorbs and retains fewer detergents. They could easily seem to
"outgrow" the eczema. But they also become more active and push more
air in and out of their lungs. Any damaging effect of detergents on the
skin is now unseen in the lungs.

Recently, a mother of an asthmatic preschooler thanked me for my web
site. Her 5-year-old developed early asthma. She’s a supermom who does
everything in her power to minimize the allergy risk in her home, yet
still they had inhalers and occasional trips to the hospital. When she
removed detergents from their home environment, they finally got the
asthma under control. Her son never had eczema.

Detergents aren't the underlying cause of the asthma, they merely
amplify other processes. Their presence in dust causes a whole set of
unseen exposures, complicated by the nonlinear effect in the presence
of small amounts of water.

A major study of women employed in domestic cleaning in Barcelona,
Spain, concluded that “employment in domestic cleaning may induce or
aggravate asthma,” and that the risks probably extend to “people
undertaking cleaning tasks at home.” [Medina-Ramon M, Zock JP,
Kogevinas M, Sunyer J, Anto JM, Asthma symptoms in women employed in
domestic cleaning: a community based study. Thorax 2003
Nov;58(11):950-4.] The study authors felt the asthma was probably
related to cleaning products but did not make specific conclusions.

A plethora of new studies demonstrate that asthma rates in the
industrialized world have soared in the last twenty years, even where
smoking and air pollution have declined. In that time, breastfeeding,
which Brazelton (and research studies) suggests is protective against
eczema and asthma, is way up in industrialized countries. And as much
as some people suggest that we are too clean today, when I was a child
in the ‘60s, I remember women under far greater social pressure to keep
clean houses, using a potent armament of cleaning supplies: powerful
disinfectants, bleach, ammonia, soaps, unmentionable chemicals we don’t
even use today like dry cleaning solvents, and they were WAY more
casual about using them. Newsweek dedicated a cover story to
the topic of how much LESS we are cleaning today than our parents did.
They smoked more, breathed in more polluted air, cleaned house more,
and had less asthma.

What they didn't have so much then, that we use now, that we eat every
day, that we are covered in from head to toe, that didn't exist on the
planet 90 years ago, are detergents. The use of detergents in
first-world home environments has increased every decade since their
introduction around World War II, skyrocketing in the last few decades.
(The use of soaps, by the way, began to decline with the introduction
of detergents, and leveled off to a constant level around 1960.)

The switch to soaps for asthma will not have the relatively rapid and
obvious effect that the switch for eczema will, because it takes weeks
for the residues to clear from the lungs. It may take two or three
months from the time a home is made detergent-free for the difference
to be obvious.

Increased Healing Times and Other Effects

Keith Green, Ph.D., D.Sc., Regents’ Professor Emeritus, Department of
Ophthalmology, and Professor Emeritus, Department of Physiology, and
School of Graduate Studies at the Medical College of Georgia (now
deceased), published a number of studies on the effects of detergents
and preservatives on rabbit eyes (rabbit eyes are a close animal model
for human eyes). I found a lot of alarmist interpretations of his work
on the web, and one even more inaccurate and misleading letter
supposedly debunking them, but I did find one web-listed paper that
seems to summarize his work fairly well: "Detergent Penetration into
Young and Adult Eyes" http://www.personalhealthfacts.com/carcinogens8.pdf.
The paper is ostensibly by Dr. Green and lists many of his references
at the end. The summary seemed a fair representation of his work:

“Using animal models, we have examined the effects in the eye of one
of the detergents, sodium lauryl sulfate (SLS), that is included in
soaps and shampoos. We also have determined how SLS is taken up by the
eye. Four findings have ensued: first, SLS is rapidly taken up and
accumulated by eye tissues. SLS is retained for up to five days in most
eye tissues. Second, SLS uptake is greater in younger rabbits with
decreasing amounts with increasing age. Third, SLS causes changes in
the amounts of some proteins of eye tissues whether they are treated in
the living animal or tissues are bathed in SLS while in tissue culture.
Fourth, SLS treatment extends the healing time of the corneal
epithelium (the cellular surface layer of the cornea) to 10 days, far
beyond the normal two days.”

No conclusions were made about the protein changes, it was merely an
observation made in the course of the research. However, since Dr.
Green was an ophthalmologist, he was concerned with the issue of
extended healing times and how small amounts of detergents might affect
healing from surgery. He did other work investigating other
preservatives and detergents from that standpoint.

When our son's eczema was at its worst, both I and my husband noticed a
marked slowing in our son's ability to heal the usual baby cuts
(usually from his fingernails, often from scratching his eczema).
Instead of a couple of days to heal completely, a cut might take ten
days or two weeks. I thought this was an interesting potential
correlation with this eye research. When we got rid of our son's
breakouts, his skin started healing normally again.

Below is an excerpt from a Reuters story (Oct. 9, 2002) about a
research study which showed slower immune response on the skin of
people with eczema — I have also wondered if this ties in. There is no
way, given what I have seen, that these patients were removed from
detergent sources on the skin for long enough — or at all — to know
whether the sluggish response tied in to the same detergent sensitivity
as my son’s. I would be very curious to know the results of an
identical study before and after people had detergents removed from
their skin and environment, and even more curious to know how lung
tissue is affected under the same circumstances in the same patients
(especially since viral problems seem to play a role in asthma):

“The new study, led by Peck Ong of the National Jewish Medical and
Research Center in Denver, found that the skin of 8 people with the
most common form of eczema, known as atopic dermatitis, was sluggish in
producing small chemicals called peptides that thwart bacteria, viruses
and fungi.

In contrast, they discovered that 11 volunteers with a similar
condition, psoriasis, had skin with high levels of peptides to fight
off germs. Even though psoriasis also breaks down the natural barrier
that keeps microorganisms out of the skin, people with that condition
are less prone to skin infections than those with eczema. Generally, 30
percent of the millions of people with eczema, characterized by itchy
red swollen skin, often in the folds of the elbows or the back of the
knees, have skin infections. That's four times higher than the 7
percent who have psoriasis, which affects 5.5 million Americans and is
characterized by the growth of unsightly patches of thick skin, the Ong
team said.”

People with other types of eczema also often benefit by removing
detergents, though they may not completely resolve their eczema.
Eliminating detergents in the diets of infants (mainly from dishes) may
be preventive by reducing allergens that enter the bloodstream early
on. I have been corresponding with a woman who has a similar
patient-run site to my own, for a type of eczema called dyshidrosis. I
believe from everything I have read that the cause of this type of
eczema is probably microbial. The eczema behaves very differently from
detergent-reactive eczema. Yet this woman has told me that switching to
a detergent-free household last year has essentially ended her
breakouts. I think just allowing her skin membrane to function normally
allows her immune system to keep the problem under control.

Since detergents are ubiquitous in medical environments — on
surfaces, fabrics, surgical tools, and even in fractionated blood
products — recognizing and understanding this sensitivity may be of
some importance to the outcome of other medical care for affected
children, perhaps all sick children.

If Your Child Might Have This Problem

If you think your child’s eczema might be caused by detergents,
removing ALL SOURCES of detergent may be necessary to tell for certain.
I note with some irony that the “before” photo used in my letter to the
National Eczema Association for Science and Education (NEASE www.nationaleczema.org) was
taken after we had already switched to soaps to wash clothing and
linens, soap to wash household surfaces, and soap for handwashed
dishes. (Download the letter and photo from the Downloads page.)We hadn’t yet realized we
needed to wash our own hair with soap, use a non-detergent product in
the dishwasher, or eliminate hidden detergents in processed foods — all
relatively minor sources compared with those we had already eliminated.
Indeed, at the time, our son’s eczema looked considerably better. But
he continued to have breakouts like the one in the photo until we knew
how to eliminate all detergent sources.

Anaphylactic Allergies Are A Different
Story

Although this is only my opinion, I believe that anaphylactic allergies
— the kind that cause deadly reactions, such as to peanuts — are
different than “normal” allergies. It is possible for anyone to be
allergic to anything, and it is certainly possible for someone with
anaphylactic allergies to also have this detergent sensitivity.
However, in my experience so far, I would guess that eczema in a person
with anaphylactic allergies is likely from a different cause than
detergents, though there may be a secondary benefit in strengthening
skin and gut membranes from reducing detergent use as described in the
previous paragraphs.

However, the risks associated with such a switch need to be considered:
many soap products come from the “natural” products sector, and
“natural” products may contain food derivatives, such as citrus oils,
nut oils, wheat protein, you name it, to which a severely allergic
child could react. Parents of children with such severe allergies know
how to track down every little ingredient in foods to protect their
children; the same vigilance is necessary here.

Other Types of Eczema With Solutions

When I first started writing this site, I felt I could only address our
direct experience. However, I am frustrated by the poor resources
parents are given to problem solve eczema. While switching to soaps is
probably a prudent step for anyone with allergies, it will not
eliminate everyone’s eczema, other measures are necessary depending on
the underlying cause. Some of these measures I hear over and over again
from parents who figured them out the hard way. I felt I should share
the most common ones.

This list is a work in progress based on observations I have made over
the years and feedback I have received from my web site. It is my
opinion at the present time and not from scientific study. I will
likely revise and update it in time, especially to expand solution
steps.

I note again that I am not a medical professional. Some of these steps,
especially #2 below, have their own pitfalls and have to be dealt with
in concert with an experienced medical professional. As anyone who has
dealt much with eczema knows, there is a wide range of knowledge and
opinion in the medical profession about eczema. It is worth finding
those doctors with relevant experience. In the case of the eczema
causes below, allergists who understand a lot about fungi, and
naturopathic physicians with a research background are probably good
resources.

As I see it, these as the major "types" of full-body eczema in children:

Detergent-reactive eczema, per this site. In the absence
of detergents in the environment, these people have normal skin and no
eczema. This eczema has been described precisely in research concerning
dermatological patch testing, so I believe it constitutes 25% of adult
eczema and what I now believe is probably 40%-60% of infantile eczema.
Now that detergents are so ubiquitous, this type of eczema almost
exclusively begins in infancy.

The increased membrane permeability from detergents probably
contributes though is not the cause in other types of eczema as well.

Given the mechanism for the eczema, measures that eliminate the eczema
should be maintained to reduce susceptibility to asthma, even as the
skin becomes naturally less permeable (naturally absorbing less
detergent and becoming less reactive to detergent exposures) with age.

Microbially-induced eczema, systemic, mainly from an
internal yeast/fungal problem but also from indoor environmental mold problems. The eczema seems to result from
something brought to the skin in sweat, so it behaves similarly to
detergent-reactive eczema. The diaper area may be clear, the skin is
most affected when and where there is sweat, washing with non-drying
soaps seems to help.

These people benefit from a switch to soaps but it doesn't get rid of
the problem. Typically they resolve the problem through dietary
changes, mainly yeast-suppression diets (not possible with an infant),
and antimicrobial measures, mainly antifungal measures that may range
from taking probiotics (beneficial bacteria) to antifungal medications
prescribed by a physician. Sometimes other support for the immune
system is also helpful.

I believe this is the segment of eczema that is largely prevented when
pregnant women and infants are given probiotics, thus I would put it at
about 25-40% of eczema cases, probably closer to 30% of infantile
eczema.

Associated with this type of eczema (prior to effective interventions)
are higher rates of: multiple food allergies and anaphylactic
allergies, learning disabilities, autism, asthma, other GI problems,
high levels of staph infection, and in adults, Type II diabetes,
hayfever, and depression. Frequent washing of the sweat and antibiotic
therapies seem to help but result only in short-lived improvements.
This type of eczema can appear at any age.

There is a great deal of literature by allergists worldwide on the
topic of yeasts and the role of antifungal medications in treating
eczema. I haven’t found any research I think of as definitive, or
offering true solutions, but each paper and experience offers pieces of
the puzzle. The following list is a good place to start, though is by
no means comprehensive.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Link&dbFrom=PubMed&from_uid=12364369

In that link alone are 157 articles on atopic dermatitis and fungi.
Such as, "Framing the future of antifungals in atopic dermatitis."

Except for the important measures of taking probiotics (beneficial
bacteria, as many strains as possible) and possibly dietary changes
that sharply reduce simple sugars and gluten, I strongly recommend
against experimenting with antifungal remedies, especially herbs, since
the potential pitfalls are far greater than with detergent-reactive
eczema. See a medical professional truly experienced in treating fungal
problems. I can’t emphasize that enough. An experienced medical
professional should be able to explain the potential for
Jarisch-Herxheimer responses in fungal treatment, and know how to
reduce it. I strongly recommend against taking any general measures
involving chronic intake of antifungal treatments (especially herbs),
since this can result in serious pitfalls, such as major depression and
gallbladder disease. A true solution more likely involves environmental
review and a course of treatment intended to completely resolve fungal
problems and restore a more normal internal microbial environment (or "microbiome" as it is now popularly called).
Proper environmental mold control and a household elimination of
detergents should drastically reduce or eliminate asthma symptoms.

Food-induced eczema. Foods involved are mainly those
with high protein/albumin content or those that contain the highest
levels of molds/mycotoxins or promote mold growth: eggs, milk, nuts,
wheat, etc. Eczema resolves when the offending food is removed from the
diet.

According to Dr. Sears, "over 90 percent of food allergies, especially
in young children, are caused by seven foods: dairy products, soy,
shellfish, wheat, tree nuts, peanuts, egg whites.” Corn, citrus, and
tomatoes are also likely suspects — especially corn which is a hidden
ingredient in so many processed foods. This type of eczema typically
begins in infancy but can begin at any age.

Eczema from albumin-containing foods is more often "outgrown" than
eczema from other foods. The foods triggering eczema may sometimes be
safely reintroduced when a child is older. In contrast to children with
detergent-reactive eczema, I think in this case the problem truly is
outgrown — the more mature gut becomes naturally less permeable and is
no longer letting those proteins into the bloodstream.

The health and permeability of the GI tract may be an issue; not eating
detergents (mainly from dishes) will probably help but will not
eliminate this problem. Eliminating detergents in the diets of infants
may be preventive by reducing allergens that enter the bloodstream
early on. Probiotics (beneficial bacteria) will likely also help (see
section on probiotics and eczema). Research has demonstrated not only
reduced rates of infantile eczema with probiotic use, but also a
reduced rates of milk allergy.

Microbially-induced eczema, mainly fungal (or then
complicated by bacterial or viral), superficial. This segment
probably includes dyshidrosis and other conditions which behave as if
the skin is infected more superficially. The eczema behaves differently
than the above types. Removing detergents may reduce frequency of
breakouts but will not resolve an existing breakout. Simplistic
antimicrobial therapies are often only temporarily helpful and lasting
relief involves steps more close to a combination of 1 and 2 above,
plus topical antimicrobial therapy and/or scrubbing affected skin with
antimicrobial solutions to end an existing breakout. This type of
eczema is more a problem for adults and far less so for infants. Immune
support or resolution of other health problems may in some cases be
enough to prevent recurrence of this type of eczema.

All children with eczema are prone to superficial infections, which can
require appropriate antimicrobial treatment before eczema will resolve,
regardless of the underlying cause. If microbial infections recur
quickly after resolving with treatment, sometimes a more thorough
approach is necessary. Underlying fungal problems, for example, can
create an environment that favors recurrence of pathogenic bacteria,
such as with chronic sinusitis.

Eczema fromlow levels of essential fatty acids
(EFA’s), which seems to respond in an uncomplicated way to EFA
supplementation, eliminating the eczema. Those in category 1 & 2
(detergent-reactive eczema and myco-responsive eczema) will likely have
no apparent benefit or may experience a slight increase in eczema from
EFA supplementation. Those with eczema that resolves with EFA
supplementation will see the least improvement from detergent removal.

Uncomplicated contact reactions from irritating
substances such as nickel or dyes and perfumes. Some of the classic
contact irritants are more likely to be problems in older children and
adults than infants. Uncomplicated contact reactions happen right where
the skin touches the irritant, so removing the contact irritant
resolves the breakouts. Eliminating detergents should decrease
susceptibility to reactions.

All other reactions, probably less than 10% of the
overall eczema population. Includes more idiosyncratic causes like
exposure to latex (another ubiquitous substance in modern households).
Removal of the offending substance from home environments and possibly
immune support typically resolve this kind of eczema.

I believe rosacea and psoriasis are probably infectious, and are a
different subject altogether — not that people with those conditions can't benefit from these strategies. There are also eczema-like rashes that
can appear after acute illness; I’ve heard of a few misdiagnosed
initially as eczema. I think they go away relatively quickly without
any intervention.

No Conflict with Natural OR Allopathic Medicine — A Matter of Perspective

Some integrative and natural medicine practitioners approach eczema by
taking general steps to strengthen the immune system. Given my own
feelings about what allergies are and aren’t, I see it as a different
approach that complements rather than conflicts with the above. When
carrying too great a load, one can either lessen the load or strengthen
the carrier. My approach is more the former, which I think is prudent
even if one decides also to do the latter. Eczema and allergies can
begin throughout life; I personally feel that the later they appear,
the more warranted is attention to the overall health of the immune
system in addition to these environmental strategies.

Priobiotics Reduce Eczema in Some Cases

Recent research on the use of probiotics (beneficial bacteria) has
correlated probiotic use by pregnant woman and infants with a
significant reduction in the prevalence of eczema and cow’s milk
allergy among at-risk infants — more than 30% reduction in incidence of
eczema.

There is a growing list of scientific publications on this topic which
can be found on Pubmed by linking to http://www.ncbi.nlm.nih.gov/ and searching on keywords “eczema probiotics.”

Full text of newer articles isn’t usually available in full, but I
believe this one can be found on the web: Kalliomaki M, Salminen S,
Arvilommi H, Kero P, Koskinen P, Isolauri E, Probiotics in primary
prevention of atopic disease: a randomised placebo-controlled trial,
Lancet 2001 Apr 7;357(9262):1076-9.

The above authors state that the probiotics used in their study are
“safe at an early age.”

Although I could cite other encouraging research on the use of
probiotics in some disease prevention — I think they are worth using
for a lot of reasons — I have my doubts that probiotic use has much
impact on eczema in detergent-allergic children. And it so happens, on
our doctor’s recommendation (for other medical reasons), I used
probiotics during pregnancy, and we supplemented with probiotics very
early, and it had no apparent impact on my son’s eczema.

On the other hand, it would be consistent with my own theory about the
underlying cause of anaphylactic allergy that children at risk for
developing anaphylactic food allergies and the systemic yeast/fungal
type of eczema would benefit from (prenatal and possibly early)
probiotic supplementation.

Until the 20th century, mothers passed beneficial bacteria to infants
in an unbroken chain for thousands of years, as did dairy animals. From
a recent review article on probiotics:

“Most probiotics fall into the group of organisms' known as lactic
acid-producing bacteria and are normally consumed in the form of
yogurt, fermented milks or other fermented foods. Some of the
beneficial effect of lactic acid bacteria consumption include: (i)
improving intestinal tract health; (ii) enhancing the immune system,
synthesizing and enhancing the bioavailability of nutrients; (iii)
reducing symptoms of lactose intolerance, decreasing the prevalence of
allergy in susceptible individuals; and (iv) reducing risk of certain
cancers.” [Parvez S, Malik KA, Ah Kang S, Kim HY, Probiotics
and their fermented food products are beneficial for health. J
Appl Microbiol. 2006 Jun;100(6):1171-85.]

Research has demonstrated the important role of beneficial bacteria in
human disease prevention. Antibiotics, for all the good they have done,
wipe out the good bacteria with the bad. They were used for decades
without much attention to restoring normal internal flora, in humans
and dairy animals. When I was a child, 90% of babies were bottlefed
with sterile milk. The chain was broken. It’s truly not surprising that
restoring normal bacteria to a child’s milk would aid digestion and
decrease the likelihood of dairy allergies and eczema in a certain
population.

Since these supplements are generally regarded as safe (so long as one
is not allergic to anything in a particular formulation, most
prominently, dairy or corn), they may be helpful as a part of a
preventive approach for allergic kids, and they may be helpful in
disease prevention (since children with eczema are more susceptible to
certain kinds of infections). There is evidence that they support the
immune system. I would personally take them in addition to a problem
solving effort, not instead of. But in this case, the potential
benefits appear to be great and according to the research, the risks
low (unless, again, someone has a severe allergy to any of the
ingredients). A probiotic supplement may be worth trying, per your
pediatrician’s recommendation.

Eczema Prevention in Pregnancy and Early
Infancy

Dr. T. Barry Brazelton (who no longer practices but teaches at Harvard
Medical School) felt that he could prevent eczema in virtually all
cases by identifying at-risk parents (when one parent had a history of
allergy) and giving them simple allergy-reduction steps to follow
during pregnancy. He points out that it's a lot easier to prevent
problems than eliminate them after the allergy surfaces. This is where
I first learned of the difference between soap and detergent, in his
description of what to do in his book Touchpoints.

In his day, there were fewer sources of detergent in households, but
even today the switch during pregnancy would be far simpler than after
eczema surfaces. Preventive steps during pregnancy would mainly involve
switching washing products. I would love to someday see a simple study
done on this. I actually called Brazelton looking for citations, and he
said he didn't have any research, he simply realized this from decades
of medical practice.

Given his experience, plus recent research on probiotics and eczema, I
would guess that following his simple allergy-reduction steps,
eliminating detergents, and taking probiotics during pregnancy would
prevent the vast majority of eczema cases in infants and small
children.

Adult Allergies Are More Complex

I don’t want to discourage adults from trying to see if detergents
cause their eczema — I have in the past year received numerous letters
from parents who cleared up a child’s eczema by removing detergents
from the household, only to discover that the measures also cleared up
the skin problems of one or more adults in the household — but adults
have a wider range of experiences, health problems, and environmental
exposures, and their skin problems can be more complex. Particularly
for people whose eczema develops later in life rather than in infancy,
I am skeptical that detergent sensitivity is the problem, though I
stand to be corrected. There might be a rationale for reducing contact
with products that increase membrane permeability as detergents do, but
switching washing products has its risks as well. If anything, adults
considering this switch need to be highly cautious in how they go about
it.

THE DETECTIVE WORK

Deciding that detergents are the main cause of eczema
breakouts takes a great deal of work. It may be obvious to you from
reading through this that your child has this problem, especially if
the eczema is very severe. This section contains some general
observations about breakouts, exposures, and the detective-work.

1)

The breakouts follow certain rules,
they aren’t random. Figure out those rules, and the breakouts make sense.

2)

Work from general hypotheses, not from
specifics that can’t be generalized.Helpful hypothesis: my
child may be allergic to latex in her pacifier, bottle supplies,
clothing, mattresses, and other sources I haven’t yet tracked down. (A
testable theory.) Unhelpful hypothesis: my child’s eczema
flares after she sits in the car seat. (Maybe so, but why? This is a
clue, not a hypothesis. Try to get a general theory that is consistent
in all situations.)

3)

Make a list of probable causes and
write it down!! Make a list of everything your child touches, eats,
or breathes that you think could be causing the eczema. Try to form
some helpful hypotheses as in #2, and write them down. Don’t just make
a mental note of everything, don’t try to analyze and weed through the
possibilities, just write them down. Once you have a list, arrange the
causes with the most likely at the top. Then think of ways to eliminate
or “test” each probable cause. Write them down, too!

4)

When you try each “test”, consider
whether the test is good enough or well-implemented enough to draw
conclusions from. If the test isn’t good enough, think of more “tests”
before drawing conclusions or throwing out the possible cause.

5)

Observe whether the rashes seem to
be from something the baby is touching (for example, the eczema
might be worse/better under the diaper area or clothing) or if it’s
from something the baby is eating (the rash might bloom after
every meal or reliably 4 days after a certain food is eaten).

6)

Timing is important: what changed
in the baby’s life in the month, days, and hours prior to the first
breakout? Add any new possible causes to the list!

7)

Timing is important!
Contact-related rashes typically happen within a few minutes or hours
of touching the irritant (remember that traces may then remain on the
skin and continue to cause reactions). Ingestion-related rashes can
happen quickly but they can also take up to a week to show up after the
offending food or substance is eaten (in my experience, most things
show up by the 4th day). If the offending food or substance is eaten
again, the rash will persist; if not, it may still take another 4 days
to a week for the rash to go away. If the rash becomes infected, it
will likely not go away until the infection is treated.

8)

In my experience, contact-related
rashes occur on the skin where the contact occurs; ingestion-related
rashes can occur anywhere, but they tend to happen in common spots
(such as the upper arms or legs) and new breakouts tend to happen where
the skin is already broken out. Because ingestion-related rashes tend
to be more persistent — provided one has a safe washing procedure to
remove contact irritants so that contact-related rashes go away quickly
— ingestion-related rashes are therefore more susceptible to infection.

9)

Breakouts are proportional to exposure:
big breakouts happen from big exposures to the offending allergen,
small or delayed breakouts happen from smaller exposures. Mitigating
factors such as a change in humidity could change the absolute measure,
but the proportional relationship still holds.

10)

Keep a detailed diary of what the
baby eats if foods are suspected, and what products are used on the
skin and other household surfaces if contact rashes are suspected. Be
exact — dehydrated rice cereal is not the same as cooked brown rice is
not the same as white rice porridge (white rice cooked for 2 hours in a
lot of water). If a washing product is suspected, remember that there
are traces left on surfaces no matter how much water was used for
rinsing. In that case, rice cooked in soap-washed pots is not the same
as rice cooked in detergent-washed pots. Canned pears are not the same
as fresh pears are not the same as processed frozen pears.

11)

Be aware of ingredients. Allergens
— even food allergens like citrus and wheat protein — may be found in
soap or detergent dishwashing liquids and dishwasher powder.

12)

Minute traces of some allergens can
cause severe breakouts. Whatever chemicals you last washed your
child’s clothing, skin, hair, bottles, etc., in — traces of those
chemicals significant enough to cause a reaction can remain on those
surfaces in spite of Herculean rinsing with water.

13)

Differentiate between what improves
the eczema, and what makes it go away completely. Is
dryness, for example, the cause, or a mitigating factor? If you think
it is truly the cause, the breakouts will be absolutely proportional to
dryness, and this can be quantified. If there proves to be no other
variable, and moisturizing isn’t enough to completely make the
outbreaks go away, a naturopath, holistic allergist, or nutritionist
may be able to recommend dietary changes to help hydrate the skin. If
the breakouts continue, or don’t track dryness absolutely, dryness may
be a mitigating factor rather than a cause, and it may be worthwhile to
continue searching.

14)

It has been my observation that bottle
fed babies are more likely to develop early, severe eczema, and eczema
in breastfed babies often surfaces when breastfeeding tapers off
(although it certainly can start during breastfeeding, especially if
the cause is a food). If eczema begins as breastfeeding tapers off, it
may be that the irritant has been present in the baby’s environment all
along — breastfeeding tends to have a protective effect with “normal”
allergy — in this case, the clues from timing are a little different.

15)

Some clues can be misleading. For
example, this detergent allergy can easily make it seem that foods are
the cause of eczema, some foods more than others because of how they
are processed, prepared, or served. Detergent sensitivity can behave
exactly like multiple food allergies or dust-mite allergies. Skin
allergy testing results could inadvertently reinforce a wrong
conclusion.

16)

Removing the allergen from one’s
environment is not linearly related to clearing the eczema, at least it
wasn’t for detergent exposure. You don’t get 50% improvement by
removing 50% of the allergen — exposures don’t quite work that way. If
you remove 99% of the sources, but your child spends a few hours in
contact with the one sheet or article of clothing you didn’t wash in
soap, you have a bad breakout to deal with. You pretty much have to get
as close to 100% detergent-free as possible. But then if you have the
right answer, the eczema will clear up as if a miracle has occurred.

17)

Once you have cleared up the eczema
entirely, it is possible to see how new breakouts make absolute sense
relative to exposures.

Your Doctor has a Wealth of Knowledge and
Experience

We gathered our list of possible causes from suggestions given by our
pediatrician, naturopath, allergist, and from the most common allergens
mentioned in parenting books (including Touchpoints). We
consulted a pediatric nutritionist along the way, too.

The medical professionals we consulted may not have had the answer for
us, but they imparted plenty of wisdom: they told us which kinds of
allergens, from their experience, caused very bad cases of eczema; they
gave us information, resources, ideas, and interpretations that proved
invaluable.

They offered practical advice: our son’s pediatrician, for example,
clued us into the difference between barrier-type and emollient-type
moisturizers, so that we were able to use the barrier-type moisturizers
to help track down contact-related breakouts.

Although our pediatrician suggested moisturizing and using cortisone
(not a solution in our case), and the naturopath and allergist
suggested such a severe allergy had to be from milk protein (which made
no sense to us given the timing), everyone gave us a clear idea of what
to expect with each suggestion, and that helped us define the problem.
Our pediatrician was pragmatic about treating infections empirically,
and this too proved invaluable. Had we needed it, the pediatric
nutritionist could have outlined a safe allergy elimination diet for us.

I can remember one watershed moment, after we had already switched to
soap products for washing laundry and household surfaces. Our son was
starting to eat solid foods, and he seemed to be allergic to
everything. I called and spoke with our pediatrician’s assistant. “He’s
allergic to pears!” I wailed, “WHO is allergic to PEARS!” “You don’t
know that he’s allergic to pears,” she said, “all you know is that he’s
allergic to CANNED pears.” She was absolutely right. It was as if a
light went on in my head. I resolved to be as analytical about the
situation as I needed to be to solve the problem completely.

We were blessed with professionals who were willing to give us the
benefit of their knowledge and experience, trust our judgment, and talk
over our concerns and anything we disagreed with. It made all the
difference. Even though they did not have all the answers — no one had
the answer we needed — we benefited from their wisdom and help
immensely. We could not have put the whole puzzle together without
their help.

It is important to have a good relationship with experienced medical
professionals when trying to solve a problem like this. They can help
immensely even if they do not have all the answers. It is really
essential to implement something this complicated in concert with a
good medical professional. They can help sort through your individual
situation from a trained perspective, ensure that everything is done
safely, and respond to any problems that arise.

The NEASE web site has a
wonderful slide show for professionals. Although it does not have this
answer, the information compiled about eczema is consistent with this
detergent sensitivity as one potential part of the puzzle. It’s a great
informational resource and worth watching. (I’ve logged on many times
when it wasn’t working, if so, do send them email.)

Eliminate Food Allergens, Too

You may wish to eliminate serious food allergens first before trying to
eliminate detergents, or you won’t know how much of an impact the
detergent elimination has relative to food elimination.

According to Dr. Sears, "over 90 percent of food allergies, especially
in young children, are caused by seven foods: dairy products, soy,
shellfish, wheat, tree nuts, peanuts, egg whites.” Corn, citrus, and
tomatoes are also likely suspects — especially corn which is a hidden
ingredient in so many processed foods.

Allergy testing can be a helpful way of discerning food, pollen, mold,
animal, and other allergies.

On that note, I feel I should weigh in on the blood vs. skin allergy
testing issue. Please remember that this is just my layman’s opinion, I
am not a medical professional. Both the allergist and naturopathic
doctors told me that allergy testing in infants before the immune
system is mature is dicey and can be misleading. In my own experience,
doctors who do skin allergy testing can be very convincing that skin
testing is more reliable, and doctors who do blood testing are equally
convincing that blood testing is just as good or better than skin
testing. I have walked out of allergists offices completely convinced
of one side or the other, depending on the preference of the allergist.

The big difference, in my opinion, is that skin allergy testing hurts.
A lot. It just seems cruel to do such tests on infants and very young
children, yet I have known any number of parents who have been talked
into subjecting their babies to them. I’m sure there must be exceptions
out there, but of the people I know, not a one feels the skin tests
were worth it. The performance of the tests depend on so many more
human factors than the blood tests, the skin tests have more avenues
for introducing errors and flaws. In the case of this detergent
allergy, skin tests could be highly unreliable. One possible result
is that the child reacts to virtually everything by skin test, but very
few things by blood test.

A Test for Detergent-Reactivity?

Detergent-reactive eczema is caused by how detergents affect skin
membrane permeability and is not a true IgE-mediated allergy. In fact,
very few people (if any) have a true allergy to detergents, most
detergent allergies are actually allergies to product enzymes and
additives. You could not test for detergent reactivity with traditional
allergy blood tests.

One of the enduring puzzles in dermatology seems to be why skin patch
testing and blood allergy testing often yield very different results.
From what I gather by reading papers on the subject, I would guess that
the tests would yield much more similar results if study subjects came
from detergent-free households.

A recent research article, which summarized patch test data for nearly
6000 patients, found that a reaction to a sodium lauryl sulfate (SLS)
patch test correlated with a “higher skin susceptibility” and greater
“skin irritability.” SLS is the most common household detergent, and
has been shown in other research to “increase antigen penetration.”

What these researchers call a “higher skin susceptibility” appears to
be in the population which is most affected by detergents’ effects on
skin membrane permeability. The researchers’ detailed description of
the eczema in these patients is identical to detergent-reactive eczema.

"..in acute eczema (allergic, atopic or irritant eczema) reactions
to patch tests can be much stronger, up to an 'angry back' reaction."
(Note: a patch would create a more moist local environment, which would
exponentially increase the detergent effect on membrane permeability,
causing a reaction regardless of the allergen tested. I do not mean
detergent on the patch, I mean traces in the skin which are likely
causing the acute eczema in the first place.)

"... patients with an increased skin susceptibility (defined as a
visible skin reaction to SLS) developed a higher rate of nonspecific
erythematous reactions to several allergens."

"An increased skin reaction to SLS will decrease again ... after
acute eczema has healed..."

In plain English, if you react to an SLS patch test — SLS being the
most common household detergent — you are also more likely to react to
many things by skin test that you aren't truly allergic to.

One of the features of this detergent-reactive eczema is that one may
be positive to many things by skin test but few things by blood test.
The apparent positive would come from detergent traces on the skin and
the nonlinear increase in local skin membrane permeability from the
increase in moisture at the test site (such as from the enclosed patch
or fluid from a skin prick test in that case).

The research describes how, when the acute eczema of study subjects
healed — in detergent-reactive eczema, that means detergent exposures
are reduced — the SLS reaction decreases again. In detergent-reactive
eczema, the reactivity of the skin to a given detergent exposure
decreases when the skin is allowed to heal and become normal away from
persistent detergent exposures, and increases again in the presence of
persistent exposures.

My conclusion from this very thorough research study is that an SLS
patch test may be useful to identify someone with this
detergent-reactive eczema. A clinical trial would have to be done to
establish how specific an SLS reaction is to detergent-reactive eczema,
in other words, how well a reaction to an SLS patch test identifies
someone with this detergent-reactive eczema — but I think the results
of this study imply that the correlation would be good.

Since sodium lauryl sulfate and similar surfactants are so ubiquitous
in home environments today, it may be useful even now to talk to a
doctor about an SLS patch test. If it is positive, these detergents
removal steps will almost certainly help. Based on my reading of the
above research, an 0.5% SLS patch test for 48 hours would be better
than the 0.25% test.

Since no research has been done on the specificity of this test for
detergent-reactive eczema — and I have no idea of the safety
considerations for infants, it’s important to ask the dermatologist or
allergist — the results should be an informative guide but not regarded
as definitive. No one yet knows the parameters for proper performance
of such a test for this purpose.

HOW TO ELIMINATE THE DETERGENTS

I received a large number of responses to my letter in the 2004 NEASE
Advocate newsletter. (Download it from the Downloads
page.) Many of the respondents had already been at the
detective work for years, and just wanted to know how to implement this
solution. Some people wrote asking for a “test” or other clues to
decide whether they had this sensitivity. The above numbered section on
The Detective Work outlines some important general clues. Here are some
specifics:

Possible Signs of this Detergent Sensitivity:

The following signs are not necessarily unique to this sensitivity, but
they may help identify it. Your baby/child may have a general detergent
sensitivity if:

He gets eczema all over, but you use disposable diapers and
the diaper area is relatively clear of eczema.

Her eczema changes noticeably, either for better or worse,
following a bath or shower.

His eczema sometimes seems to fluctuate wildly from day to
day.

Washing just with water can sometimes cause an outbreak.

She gets particularly bad eczema on her cheeks or chin where
she rests it on your shoulder or against your hair when you hold her.

His pattern of eczema from foods is inconsistent or follows
strange lines: he might seem allergic to cooked or canned foods but not
to fresh ones, or he reacts more to cooked foods than to raw ones (if
it’s a protein allergy, it should logically be the other way around).

Her eczema is worse on exposed skin, especially as she crawls
around during the day.

Sweating makes the eczema markedly worse. Or the eczema is
worse in areas that remain moist, such as behind the knees.

He reacts to just about everything on the allergy skin tests,
yet his blood tests show very few allergies.

Her eczema does seem related to what you are using to wash
her or the laundry with, but switching products has maybe improved it
but never made it go away.

He seems to get eczema from just about everything he touches
and eats.

His eczema improved after infancy, but you just can’t seem to
make it go away. After the eczema started getting better, the asthma
symptoms started up.

A Simple “Test”

Important note (July 2007): I used to recommend unscented Dove
for this test. As of January 2007, the makers of unscented Dove have
discontinued the product and changed the surfactant formula in
unscented Dove Sensitive Skin. Until further notice, I cannot recommend
unscented Dove Sensitive Skin at all. Most especially, do not use it
for the washing test. I am searching for an equivalent replacement.
Until I can find one, use Sappo Hill Soapworks unscented bar soap. As
always, test on a small area first for individual sensitivities.
For more information about the changes to unscented Dove, see my blog www.solveeczema.wordpress.com
.

I have suggested the following to some people as a simple “test” to
judge whether more “tests” or work are warranted. It is not foolproof.
People can be allergic to anything; if one has a specific allergic to
any of these products, the results will be misleading. If the eczema is
infected it won’t clear up even if this is the answer. This test will
only affect contact-related eczema (eczema from touching the irritating
substance), it will not affect ingestion-related eczema (eczema from
eating the irritating substance).

The principle here is to remove all detergent residues from the skin
and coat it with a thick layer of a barrier moisturizer long enough for
the skin to start healing. This “test” will allow the skin a few hours’
relief, enough to see a difference in contact-related eczema. If one
has this detergent allergy, emollient moisturizers will make things
worse and should be avoided for this test. Detergents are so
ubiquitous in our environments, and so persistent in human tissue,
water alone will not be sufficient to remove them.

The washing product I recommend for removing the detergent residues for
this test is Cal Ben's liquid dishglow from a foaming dispenser. Do not
use it straight as it is quite concentrated. Rinse especially well.

Remember that some residues of anything you use will be sealed in by
the barrier moisturizer — if you have any concerns, consult your doctor
and if necessary, start with a small area as a test for individual
allergy to the soap ingredients or the Aquaphor.

SUBSTITUTING A DETERGENT PRODUCT FOR THIS TEST IS NOT OKAY, EVEN
IF THE DETERGENT IS COMBINED WITH OILS. DO NOT SUBSTITUTE WITH A
DETERGENT PRODUCT LIKE CETAPHIL, EVEN IF IT IS CONSIDERED
“HYPOALLERGENIC”. Cetaphil may be a great product for someone like me
who is not allergic to detergent. But it is a problem for someone with
this detergent allergy. One mother I was trying to help used Cetaphil
without telling me, and her child’s skin blistered. Use only a good
cleansing true soap for the purposes of this test.

Barrier moisturizers include Aquaphor and Vaseline Petroleum Jelly. One
person responded to my letter in the NEASE Advocate by making a general
recommendation for a product he manufactures called Hydrolatum, which
appears to be a benign barrier moisturizer as well, though I have no
experience with it myself.

Eucerin (made by the Eucerin company, which also makes Aquaphor) is NOT
the same as Aquaphor and is NOT a barrier moisturizer for the purposes
of this test.

Please be aware that words for moisturizer categories are non-standard and even contradictory. Some researchers in the UK have published papers touting "emollient" moisturizers as best for eczema sufferers; the specific types of products they mean are the same as I describe as "barrier" moisturizers.

The Washing Test/Washing Procedure:

Please read through the entire washing procedure before starting;
safety in the bathroom comes first. If it’s not possible to follow
these instructions safely, another option is to wash a cup for rinsing,
or the bathroom surfaces, or anything else as necessary, with soap, and
rinse well. Cal Ben's liquid dish soap (straight) works well for
removing detergents from hard surfaces. Rinse well, it is quite
concentrated.

The best time to do this test is in the evening just before your child
goes to bed, because s/he will be less active.

First wash your hands well with the Cal Ben's dish soap foam. Rinse
them well under the tap. Dry them only with new paper towels such as
Bounty, not with fabric towels. Try to take the paper towels right off
the roll, don’t set them on a flat, washed surface.

If your child gets eczema on his/her lower arms or legs, wash one arm
or leg well with the Cal Ben foam (using your hands or paper towel, not
a washcloth). Rinse the arm or leg well under the tap only, not in a
bath or sink. Do not use a container to pour the water. Use the water
directly out of the tap and use your hands if necessary to direct it.
Do not let the skin touch the sides of the sink or tub. If that
happens, wash and rinse the skin again.

Dry only with paper towels. Do not allow the washed skin to contact
anything (especially not your clothing) before slathering it with a
thick layer of a barrier moisturizer like Aquaphor. If you have a used
tub of this moisturizer, be sure to scrape off a layer of it with your
soap-washed hands before using it so that no residues of detergents
from past use have made it into the mix.

Immediately following this procedure, the bumps or skin may look a
little redder for a short while, even if the procedure is helping, but
the redness should go away fairly quickly. The skin should not start to
break out, and it shouldn’t hurt or itch more. If your child
experiences a bad reaction of any kind, immediately wash everything off
with whatever you normally use and call your doctor. (I’m not expecting
a reaction, but as I said, people can be allergic to anything.)

If the procedure is helping, the eczema should look improved within as
little as a half hour. If your child’s eczema in the test area looks
markedly different after a few hours, then there is a good possibility
that a contact reaction to detergents is involved; it’s a virtual
certainty that a contact reaction of some sort is involved.

If your child’s eczema doesn’t look different at all, it could be
because the eczema is ingestion-related rather than contact-related, or
because it is infected and will have to be treated before it will go
away.

If the eczema on the tested areas virtually disappears with this test —
at least for a few hours — then making the switch to soaps will
probably help. If this “test” works well, then this washing procedure
will help whenever contact rashes appear from unknown sources outside
the home. We’ve brought our son home covered in eczema from contact
with the dentist’s chair or other people’s clothing, and the breakouts
quite literally wash off. Even a bad breakout is usually gone
completely within the hour when it’s washed. I’ve heard this from other
people I’ve helped, too, that you can almost see the eczema wash away.
(Once you have soap-washed towels and bathroom surfaces, this washing
procedure gets a little easier.)

SWITCHING TO SOAPS

The most commonly asked question of people who responded to my letter
in the NEASE Advocate was: where do I find soap products?! I put a list
at the end of this discussion. I tried to include as many different
kinds of soap and non-detergent products as I could; I have not used
all of them, and I am not endorsing any of them. It’s always possible
that I have overlooked a detergent ingredient in a product I have not
used; I tried to be careful, but these days even very thorough research
isn’t always enough. Please read the entire discussion before making
any changes. Be aware that sometimes companies will switch ingredients
without warning. It pays to be aware of the developments in surfactant
chemistry and labeling to know what you are using.

A Brief History of Cleaning Products

The American Cleaning Institute has a nice and pretty accurate history of soaps and detergents, and some basic chemistry. The history of soaps and
detergents is well worth reading, especially the last section that
describes the introduction of new detergent cleaning products
in the 20th Century. (The link has changed - it's easy to find using a search engine.)

Soaps and detergents are both surfactants. They are similar, but not
the same. Humans have made soaps for thousands of years, by reacting
fats or oils with alkaline substances, such as ashes or soda ash.

Detergents are an invention of the 20th century. From the Soap and
Detergent Association (SDA) web site http://www.sdahq.org/cleaning/history/soaphistory3.html
:
“Household detergent production in the United States began in the early
1930s, but did not really take off until after World War II. The
war-time interruption of fat and oil supplies as well as the military's
need for a cleaning agent that would work in mineral-rich sea water and
in cold water had further stimulated research on detergents.”

The web site further defines detergents thusly: “…synthetic detergents
are non-soap washing and cleaning products that are ‘synthesized’ or
put together chemically from a variety of raw materials. The discovery
of detergents was also driven by the need for a cleaning agent that,
unlike soap, would not combine with the mineral salts in water to form
an insoluble substance known as soap curd.”

Detergents can be synthesized from many different kinds of starting
ingredients, but were mainly developed from petroleum. In developing
something similar to soaps, the aim was also to overcome the
shortcomings of soaps — to make something that would work over a
broader range of water mineral conditions and temperature extremes.
Soaps and detergents thus historically differed both in their starting
ingredients and in the chemical properties of the end result.

Initially, the general public distinguished soaps and detergents only
by their starting ingredients: surfactants made from plant and animal
fats were called soaps, surfactants made from petroleum were called
detergents. Especially during the times of fat and oil shortages, it
was a valid distinction. To this day, many people still distinguish
soaps from detergents this way.

By the SDA definition, however, detergents can be made from other
ingredients. In today’s climate, petroleum derivatives have lost favor
with consumers of “natural” products. Manufacturers have filled the
niche with a plethora of products synthesized from non-petroleum
starting ingredients — considered more “natural” by some — and which
work better in hard water than soap.

By the SDA definition, such products could be considered plant-based
detergents, especially where they have different washing and molecular
charge properties than traditional soap. But because of the
long-standing public understanding of soaps and detergents as
differentiated by their starting ingredients, many of these
manufacturers justifiably call these products “non-detergent” or
“soap-based.”

For the purpose of switching from detergents to soaps to eliminate this
eczema, most of these plant-based surfactants would be considered
detergents, not soaps. Unfortunately, the confusion in definitions
makes an already difficult hunt for true soaps even harder.

I think this is one reason more people haven’t figured this difference
out today as Dr. Brazelton did in his practice.

If You Make the Switch, Stick With
Traditional Soaps

If you are trying to make this switch from detergents to soaps,
use only traditional soaps. Products that contain soap will say
“soap” as the first ingredient on the INGREDIENTS label. All-soap-based
products will not have further “nonionic vegetable-based surfactants”
or other non-soap surfactants listed in the ingredients.

It is possible that a manufacturer could list a soap ingredient as a
“vegetable-based surfactant.” If the manufacturer otherwise advertises
that the product is a soap product (as opposed to a detergent), follow
up with questions. Ask point blank: is this product a traditional
anionic soap? In my experience, sometimes it is, most of the time it is
not.

In one case, the maker applied the historic distinction between soaps
and detergents, and claimed in an email that their product was a soap
product, even when it was clear from the label that it was a
combination of a soap and a nonionic vegetable-based surfactant,
clearly not all traditional soap.

The word “soap” means absolutely nothing on
the FRONT label of the product and is commonly used for detergent
products. Even organic or “natural” products that say “soap” on the
FRONT label are often all detergent and contain no soap.

Some products on the market are a combination of traditional
soap and “nonionic vegetable-based surfactants.” I do not know if these
products are okay for children with this allergy. I suspect that some
of them may be, particularly if the nonionic surfactant is a minor
ingredient relative to the soap, but I would not recommend trying them
initially because the effect is unknown. If you clear up the eczema by
making the entire switch, you can always experiment with new products
later. But this switch is so much work and fraught with so many
pitfalls as it is, I would not personally recommend adding an unknown
like a combination product to start.

Many cleaning products on the natural-store shelves are made from 100%
nonionic vegetable-based surfactants. I do not know if these products
are okay for children with this allergy. I strongly suspect that they
are not. I would consider them detergents for the purposes of this
allergy. Parenthetically, a spokesperson from Nikwak pointed out that
their company deliberately does not use nonionic vegetable-based
surfactants in the soap washes they make for waterproof high-tech
outdoor fabrics.

Water conditioners like Borax or Oxo-brite are not detergents and are
okay so long as one does not have an individual allergy to them. I use
them in addition to soap, not instead of. Many soap-based washing
products contain other ingredients to boost the efficacy of soap, which
is okay, again, so long as one does not have an individual allergy to
the ingredients.

Even if you do everything by the book, and your child’s eczema proves
to be caused only by detergents, you will probably still have detective
work to clear the eczema 100%. Be diligent and don’t guess. If you want
to make this switch and have any concerns that something MIGHT not be
traditional soap, don’t use it. Stick with what you know.

Soaps do a marvelous job of cleaning in soft water; in my personal
opinion, the result with soaps is better than from detergents in soft
water. But since the introduction of detergents, which work over a
broader range of water conditions, home water softeners have become
rare. Absent soft water, consumers complain that soaps don’t work as
well, and stopped using them. At the end of the 20th century, true soap
flake makers began to pull their products from supermarket shelves.
Ivory Snow, once the premier soap flake for baby clothing, became a
detergent about ten years ago. White King stopped selling soap flakes
in stores around 1998. I do not know of any traditional grocery or
natural foods chain that sells true soap flakes anymore in the United
States, though they can be found in markets in countries like France
and England. I have a provided a list of online sources in the List of Products.

One term you can completely ignore here is “hypoallergenic.” According
to the eco-labels site, “There is no government or official definition
for this term.” According to the evaluation by Consumers Union, “The
hypoallergenic label is not meaningful.” And “…the Food and Drug
Administration (FDA) states that ‘There are no federal standards or
definitions that govern the use of the term ‘hypoallergenic’. In 1974,
the FDA tried to establish definitions for the use of the term
hypoallergenic, but the regulation was overturned in court.
Manufacturers of cosmetics labeled as hypoallergenic are not required
to submit substantiation of their hypoallergenicity claims to the FDA.”
Furthermore, “The FDA ‘does not know of any scientific studies done to
see if ‘hypoallergenic’ products produce fewer allergic reactions than
those that don’t have the claim.’ The same is true for the terms
‘dermatologist-tested,’ ‘sensitivity tested,’ ‘allergy tested’ and
‘nonirritating.”

The term “natural” is no more helpful. “There is no government or
official definition for this term except on meat and poultry products."_top_

Important Points

Switching to soaps is a lot of work.

Clearing up eczema by removing the detergent exposures in the
environment is not a linear process. You don’t get 50% improvement by
removing 50% of the sources, exposures don’t work that way. If you
remove 99% of the sources, but your child spends a few hours in contact
with the one sheet or article of clothing you didn’t wash in soap, you
have a bad breakout to deal with.

You have to get as close to
100% removal of all sources of contact as possible to eliminate the
eczema.

If you are willing to do the work, and this is the problem, the results
are nothing short of miraculous. If you aren’t willing to do the work,
it’s probably not worth the effort to do it half way, because you
probably won’t even see half improvement.

On the other hand, the reactions are proportional. Two hours spent in
contact with a fabric washed in a strong detergent will cause worse
eczema than two hours spent in contact with a fabric washed in a mild
detergent. This is why, for example, someone with this allergy might
see an improvement using a mild detergent like Dreft, yet fail to
eliminate the eczema.

To get 100% removal of all sources, at
least at the start, everyone in the household should make the switch if
feasible.

Your child spends time in contact with you and your clothing — if you
don’t make the switch she will be exposed to detergents every time she
touches you. Your clothing, skin, and hair will continue to leave
detergents in the household dust from lint, skin cells, etc. Combining
soap and detergent laundry products in the wash is problematic, and
detergent residues in the dryer will have to be constantly washed out
rather than once at the start. It’s better if everyone switches,
provided everyone tolerates the switch. You can always experiment with
changes once the eczema is cleared up.

One of the things that I remember from working in chemistry
labs (before studying engineering) is how incredibly difficult it is to
remove all residues of anything from any surface. Detergents can be
very persistent. Think of nothing as clean; _top_ think of everything as coated in a layer of
whatever it was last washed in at the very least. For the purposes of someone who is very allergic, you can’t really wash
anything completely away with water. You can only find things that
don’t cause the rashes to wash away the things that do.

There are grades of detergent
strengths.

The stronger detergents seem to be a greater problem for children with
this allergy. All are a problem for children with this allergy if you
want to make the eczema go away rather than just improve it. Many
detergent products are mislabeled as “soap”, but you can tell the
difference by reading ingredients.

One chemist told me that many
detergents have a chemical name that resembles sodium lauryl sulfate,
i.e., “sodium [something something something] –ate”. The chemical names
will start with sodium or potassium. This is not true of all detergents
by any means. When in doubt, check with the manufacturer — ask if any
of the ingredients are classified as detergents. The online dictionary
www.thefreedictionary.com is another good resource for checking the
classification of some chemicals. The National Institutes of Health and
the National Library of Medicine sponsor a site http://householdproducts.nlm.nih.gov/index.htm.
You can type in the names of household products or the chemical names
and get a flood of information about them, such as the entire
ingredients list. If you find a chemical using the search function,
click on the link to chemical information. Once there, click on the
“Full Record” link on the left side of the page. You won’t find “this
is a soap” or “this is a detergent” stated explicity, but the
information is usually in there somewhere.

The Environmental Working Group http://www.ewg.org has a cosmetics database with thousands of personal care and household products. For every product, there is a list of ingredients and specifics about each ingredient. These entries should say whether an ingredient is a detergent/surfactant.

Traditional soaps are anionic.
“Nonionic vegetable-based surfactants” are not traditional soap, even
if they have been made with plant-based fats.

However, some of the plant-based soap/nonionic surfactant combination
products may prove to be okay for this allergy, I don’t know. I would
not start with these or any of the 100% nonionic products. Once you
clear up the eczema, you can switch products one at a time to see if
they are okay. Many detergents that cause this eczema, like sodium
lauryl sulfate, are anionic like soap— the molecular charge is not the
deciding variable here — but knowing soaps are anoinic can help you
avoid compounds that are not traditional soap.

True soap is a premium ingredient. While manufacturers have many vague or complex terms for detergents, such as "nonionic surfactants," soaps are a very specific product that can be identified on ingredient labels much more easily. There may be legal reasons for this, too. A product is a true soap if the INGREDIENTS label says:
"soap"
"saponified [oil]", e.g., saponified olive oil (which is castile soap)
"castile soap", which is one of the most common soaps
simple chemical names for soap, e.g. sodium cocoate (soap from olive oil, or castile soap), sodium tallowate (soap from tallow), sodium palmate, etc. Soaps can also be made with potassium hydroxide, in which case, for example, soap from olive oil would be "potassium olivate".

Traces of detergents significant
enough to cause severe eczema persist in clothing in spite of Herculean
rinsing. An extra rinse or two is nothing with this allergy. Traces of
detergents stay on dish surfaces despite repeated rinsing with water.

Fragrances are not the issue either, though
they are common irritants; the problem here is the detergent.
Fragrance-free detergent is not the solution here.

This solution is a great deal of work at
the outset, but it does get better.

On balance, I felt it was easier to take steps to prevent the eczema
than to cope with the problems caused by it. Once we eliminated the
eczema, our son’s skin became stronger and less fragile. Once it healed
and wasn’t broken out all the time, it was less susceptible to
breakouts from dry contact with detergent-washed surfaces.

Wet contact with detergent-washed
surfaces — contact in the presence of water — is a more serious problem
than dry contact.

This is why sweating causes someone with this allergy to break out.
(Fortunately, if detergent sensitivity is the cause, the sweating
outbreaks can literally be washed away by the above washing “test”
procedure, as can virtually all contact-related eczema.)

Infected patches have to be treated
before they will go away.

Bacterial problems may be obvious, but for the most part, fungal
problems are hard to diagnose and have to be treated empirically.
Having a good pediatrician or dermatologist who is experienced and
willing to work with you is key. Be alert for antimicrobial products
containing ingredients that cause breakouts. Try to find ones that
don’t cause breakouts (of the ones we’ve used, only a few did, most did
not). When the antimicrobials caused breakouts themselves, in our
experience, neither the infection nor the eczema cleared.

In my experience, tallow soaps give the
best results and are the least drying.

Vegetarians should take care as tallow can come from animal fats. In
fact, I thought all tallow came from animal fats, but the soap we use
from Cal-Ben Soap Company lists ingredients as “vegetable-based tallow”
or from “vegetable tallow oil.” If the source of the oils is important
to you, please double check with the manufacturer.

I’m sorry to say this, but if you
don’t have access to your own washing machine and dryer, I don’t know
how to advise this switch.

Machines at a Laundromat would have such high levels of detergents in
them, I personally couldn’t see a way to realistically use them for the
purposes of switching to soaps. Combining soap and detergent laundry
products in the wash can be a bigger problem than the detergents alone.
(More on this later.)

Most people underestimate how big an impact water hardness has on their ability to wash anything and on their skin. Hard water by itself does a poor job of rinsing, whether it’s soaps or
detergents. Recent medical studies from England demonstrate that the
incidence of eczema in areas with hard water is greater than the
incidence in areas with soft water. [Atopic eczema and domestic water
hardness, NJ McNally, et al, Lancet. 1998 Aug 15;352(9127):527-31.] If
you have very hard water, my suggestion would be to install a
mechanical water softener. You can use chemical softening agents like
Borax, but having a mechanical softener works much better. (Please refer to my blog for a discussion about research studies on water softeners and eczema, as well as possible detergents in some water softener salts.)

If you have hard water, the transition to soft water is an adjustment.
All surfactants foam better in soft water, so you use far less to wash
hair, dishes, laundry. At first it seems harder to get things clean,
until you realize it’s only because of superior sudsing. When you
realize that all of those residues remained in your hair and clothing
with hard water, and that the feeling you associated with “clean” was
really the friction from unwashed residues, then you appreciate how
much cleaner you are with soft water!

It is possible to get by without a softener if you have medium water,
but if you have hard water, it may be necessary to get a mechanical
softener to make this switch to soaps. Hard water can be a serious stumbling block to implementing the site strategies well.

Step 1: Get a good vacuum. Seriously.

The household dust contains detergent residues. If you don’t already
have a good HEPA or electrostatically filtered vacuum, get one,
preferably with a hose attachment for dusting surfaces. Be sure to get
a high quality one — I know about at least one cheaper product that
leaked the air around the electrical cord without filtering it.

Miele makes very good vacuums, but there are many others. Having a
household air filter is not the same thing, the vacuum is essential for
removing detergent dusts from carpets and other surfaces. In this case,
dusting by vacuuming is the way to go, not wiping with a wet rag!! You
may have to change the filters more often than recommended by the
manufacturers, especially if you use electrostatic filters.

Keep up the vacuuming throughout the detergent removal process. Once
you’ve made the switch completely, your dust won’t contain detergents
anymore and you can reduce the vacuuming to whatever level you need for
general allergy control. It may be impossible to remove enough residues
from fabric floor coverings, but in my experience, low levels of
detergents can come off of nylon carpeting over time just from
vacuuming.

Children who get severe eczema like this generally have other allergic
susceptibilities. A vacuum with an adequate filter is an important
allergy control measure.

Step 2: Superwash the laundry.

Fabrics that have been washed in detergent have stubborn traces of
detergents in them, often high levels of detergents if they have been
washed many times. Most people with eczema use the extra rinse cycle,
but it’s really nothing when it comes to this allergy.

It’s necessary to do extra washing at the start to remove detergents
residues in fabrics. This is such a difficult but important step, it’s
a good idea to sequester the things that have already been superwashed
in soap. New clothing and towels have detergent residues in them
usually, but it’s far less than the clothing most people already have.
Once you have removed the detergent residues entirely, you will be able
to wash everything normally with soap.

Again, it’s not a good idea to just wash the baby’s things in soap and
everyone else’s in detergent. Don’t mix the two, make the switch
entirely until you see the results.

As I have tried to help other people with this allergy, I have come to
the conclusion that it is necessary to completely remove detergent
residues with soaps, or the intermediate stage with residues of both
can actually be more irritating. (A microbiologist who understands
detergent chemistry has offered me an explanation for this, but I will
have to ask about it a few more times before I understand it well
enough to pass along.)

I wish I could give exact advice for superwashing the clothing, but I
don’t have all the answers. When I get hand-me-down clothes from other
people, sometimes I have to wash them ten or more times in soap before
I get enough detergent residues out that my son stops reacting to them.
(Water alone in this case would be hopeless.) Don’t despair, though, I
don’t think it’s necessary to do that much washing in all cases.

It’s even more difficult to remove residues from some synthetics than
cottons, so my suggestion would be to start only with 100% cotton
clothing and fabrics. This summer, for example, my son wore some
hand-me-down cotton shirts that had been washed many times and didn’t
seem to give him any trouble. But when it got hot and he sweated, he
got a ring of eczema around the collar area — it turns out, the
synthetic combinations in the collars don’t have to be labeled, and
they hang onto the detergent residues better. I knew this was contact
eczema because it “washed off” using the washing procedure outlined
previously. When I washed the shirts several times more with soap, they
no longer caused the eczema where the collars touched my son’s skin,
even when the weather was very hot.

Products like Borax, Oxo-brite, or old-fashioned washing soda (Arm and
Hammer sells one) can help boost the efficacy of the soap flakes.
Vinegar might help remove residues, but use it alone, don’t use it with
the soap; vinegar lowers the pH, soap works better at higher pH.
Vinegar in the laundry can make blue dyes run, don’t use it with blue
and purple fabrics. I’ve never used vinegar with soft water, I suspect
it’s not necessary.

What I suggest to people at a minimum to start is this: wash the
laundry once or twice with soap flakes and a booster like Borax or
Oxo-brite, then do one more full wash cycle with just soap, then do at
least two more wash cycles with just water (nothing added). Use the
prewash and extra rinse cycles each time if available.

Before drying the first soap-washed load, wash the detergent residues
out of the dryer the best you can. Again, I don’t have any exact advice
to give, just don’t use detergent-washed rags, and don’t expect water
alone to do the job. One possibility might be to use a true soap
dishsoap product to wash out the detergent and fabric softener
residues, then rinse very, very well with soap-washed rags. (That works
nicely if your first load of superwashed fabrics is a load of rags!)

Remember to wash any laundry room surfaces on which you set the
clothing with soap (preferably a good dish soap — but be careful, these
are the most frequently mislabeled when they are actually detergent).
Also, wash your laundry basket the first time as well. Don’t take
anything for granted, every detergent exposure could affect the outcome.

Do not use fabric softeners. If your laundry comes out so hard that you
think you can’t live without them, your water is probably too hard for
effective cleaning with soap. Once the laundry has been superwashed,
and the eczema eliminated, it may be possible to reintroduce a liquid
fabric softener, using extreme caution with the ingredients. I wouldn’t
recommend adding back a softener, but some people feel it’s necessary.
Do not use a fabric softener during the superwashing process, it makes
the detergent residues harder to remove and may be an independent
source of allergy problems as well.

A note on fabric flammability and
soaps/detergents:

I know very little about this topic, but since it is a safety issue, I
will simply pass along what I have read or been told.

Some clothing, especially polyester children’s clothing, specifies on
the label that it should be washed in detergent, i.e., not soap,
because the flame retardant properties are affected. Polyester is now
the standard for flame retardant children’s clothing. When Ivory Snow
switched from being a soap product to a detergent product, a company
spokesperson admitted to me that this was one reason, probably over
potential liability concerns.

I wrote the American Fiber Manufacturers Association (AFMA) about this
issue, and this was the response:

As for the effects of soap on fabric flammability, the major
effect comes from the calcium and other metal ions left on the fabric.
The effect is, of course, more pronounced when using hard water. The
calcium interacts with the fatty acids that make up the soap. This
interaction can form insoluble soap residues that may remain on the
fabric. If there is sufficient buildup of this residue, the fabrics may
become easier to ignite and may burn more easily. This can happen with
virtually all types of fabrics - natural and synthetic.

Most detergents are made up of materials that do not form insoluble
calcium salts, so there is less of an effect. Calcium salts can still
build up and affect fabric flammability, but the residues do not
contain the fatty acids and usually produce a smaller effect on the
fabric's burning characteristics.

While these effects can be clearly demonstrated in laboratory tests,
such as the test required for children's sleepwear, they are not
something that most consumers would ever notice. Fabrics washed in soap
or detergent can be safely worn as long as reasonable safety
precautions are observed. All fabrics will burn under the proper
circumstances and should always be protected from potential ignition
sources.

It may be another reason to get a mechanical water softener (which
removes calcium) if one plans to use soap for the long term. I do not
know the implications of using soap and soft water and whether that
solves this problem or not.

The government standards for flame-retardant children’s clothing also
include snug-fitting cotton clothing.

Step 3: Wash all household surfaces with soap
and rinse using running water when possible, and soap-washed rags or
towels if not — chairs, tables, counters, sinks, floors, high chairs,
etc. Don't forget the baby equipment like strollers, playpens, etc.

From this point on, use soap rather than detergent products to wash
household surfaces. Disinfectants like pure bleach are not detergents,
though they can be irritating unless properly removed. Vinegar is an
effective household cleaning agent, as is borax. If you decide to use
disinfectants like Lysol cleaner that contain detergents — I do
sometimes — just be sure to wash the same surfaces well with soap to
remove the detergents after disinfection. (Do not mix any of these
products together.) Soap should be sufficient for most household
cleaning.

If your child takes a bath in a tub used by the rest of the family, you
will have to scrub it well with soap to remove all detergent residues.
Virtually all shampoos these days are detergent products. Even tiny
traces remaining on surfaces can cause severe eczema. Exposure to
detergents in the presence of water is a much more serious problem than
dry exposure. It is essential to be fastidious about removing detergent
residues from bathroom surfaces and completely switching to soaps, or
be religious about washing off the detergents before every use by your
child.

For surfaces you cannot wash with soap, such as a sofa or stroller seat
that cannot be washed, it may help to put a layer between your child
and the surfaces, such as laying down a soap-washed sheet or baby
blanket. Just a warning — one layer may not be enough. My son got some
eczema through three layers of fabric — fabrics are not impermeable —
we had to wash the stroller seat in soap to keep him from reacting.

Step 4: Wash all the dishes, pots, pans,
utensils, and all other food preparation gear with true dish soap or in
the dishwasher with non-detergent dishwashing powder.

It is not necessary to superwash hard surfaces like dishes, but rinsing
with water alone is not enough. Use a dish soap to remove dish
detergent residues.

Before you start, be sure to throw away the old sponge that contains
detergent residues, and use only soap-washed kitchen towels or paper
towels from now on. I think new sponges may contain detergent
surfactants, try to “wash” them out with soap. The dried sponges from
Trader Joe’s are probably a good bet — this is just a guess, but my
suspicion would be that the detergents in new sponges are there to keep
them soft (detergents are highly hydrophilic and don’t dry out easily),
therefore the dried, super-compacted sponges probably don’t have a lot
of detergent in them if they have any at all.

This is probably the easiest step, it just requires throwing away the
old sponge and switching to a true dish soap and non-detergent
dishwashing powder, and making sure everything used from that point on
has been washed in soap._top_

Step 6: Make bath time an eczema-removal time

You will still come into contact with detergents outside the home. As
your child’s skin heals, it will withstand these contacts better, but
you will still need to remove them on a regular basis.

There are different theories about bathing when it comes to eczema.
Some doctors think bathing and moisturizing every day is important for
hydration. Some doctors think it causes dry skin and suggest bathing as
infrequently as possible.

We came to the conclusion, for our son at least, that bathing every day
was too drying. While it removed the detergent residues, it also made
his skin more susceptible to outbreaks from lower levels of detergents.

We also came to the conclusion that washing only once a week wasn’t
enough, because the detergent exposures needed more frequent removal to
keep the skin healed.

Bathing twice a week, or every other day in summer, is probably a good
balance, at least it was for us. We didn’t plan the baths on a
schedule, rather we tended to bathe after major exposures every few
days. Scheduling baths after play or visits outside the home that bring
your child into contact with detergent-washed surfaces is a good
contact-eczema control measure. If your child attends preschool and
comes home every day with a contact rash, bathing every day is probably
unavoidable, just be sure to wash with a true, cleansing soap (like Cal
Ben's liquid dish soap from a foaming dispenser), rinse well, dry with
your soap-washed towels, and coat the clean skin with Aquaphor or
another barrier moisturizer immediately after. As the skin becomes
stronger and the home more and more free of detergents, the Aquaphor
may become unnecessary, especially in the summer.

Before applying barrier moisturizers, use the washing procedure to
clean skin of any detergent residues that may have accumulated during
the day. If you cover the skin with a barrier moisturizer, you seal in
whatever is underneath, and a reaction will follow if your child’s dry
skin has any detergent dusts on the surface. The dry skin may not
react, but once you put the barrier moisturizer over it, the skin
becomes more moist and permeable under the barrier, and thus more
susceptible to any trapped detergent residues.

Bathing only removes contact eczema, it will not remove
ingestion-related eczema. Bathing will not remove infected eczema,
which usually needs treatment before it will go away.

Step 7: Remove or Reduce Detergents From Food
Sources

Washing dishes and kitchenware in soap removes the greatest source of
detergents in most people’s diets. Normal cooking and eating from
detergent-washed dishes can introduce significant traces of detergents,
from some foods more than others depending on the preparation or
serving method. It may mistakenly seem as if those foods are causing
the eczema.

Once the dishes and kitchenware have been washed in soaps, detergents
in foods are a lesser part of the problem but the toughest to ferret
out. To get rid of the eczema completely, it is necessary to eliminate
detergents in foods entirely. If you get a huge reduction in eczema
from transitioning to soaps, but there remain hard-to-pinpoint
breakouts that tend to be in the same areas, they are probably from
detergents in foods.

A woman in New Jersey, whose 3-year-old son had been the worst case of
eczema in her pediatrician’s practice, said she and the pediatrician
used to cry together over it. Early in our conversation, she gave me a
long list of foods she thought her son was allergic to. After she was
able to clear up the majority of his eczema by switching to soaps, she
said that he was only allergic to nuts and eggs after all.

This is a tough step to talk about because people can quickly become overwhelmed thinking about it. But there are a few places to look for the biggest sources.

Many processed and prepared foods have detergents in them, as we have
found. At least, when our son has gotten eczema from certain foods and
we’ve been able to get the same food completely unprocessed or with
absolute certainty that no detergents were introduced, he didn’t react
to them. He got eczema, for example, from canned, jarred, pureed, and
frozen peas, but he did not get eczema from fresh peas that we shelled
and prepared in our own soap-washed kitchen.

It would have been easy for us to assume he was allergic to rice: he
reacted to the processed baby rice cereals, so we gave him cooked rice
porridge. He reacted to that. We of course observed these reactions
before we figured out the detergent sensitivity, but we initially
assumed he was allergic to rice. I wonder how many people do the same
thing as we did, and assume their child is allergic to rice after they
cook it themselves, not realizing the allergen could have come from
whatever the pot was washed with.

Detergents get into foods during processing. When I say “processed,”
I’m not just talking about foods people usually think of as processed,
like Twinkies, but foods people think of as basic, like milk, oil,
eggs, bananas, and poultry. If anybody did anything to the food except
pick it and bring it to the market, consider it processed for the
purposes of this discussion. The more that has to be done to the food
to prepare it, especially in the presence of water, the more
opportunities to introduce detergents.

Infant formulas might have detergents in them, or at least that was our
deduction from our experience. We tried virtually every major brand
sold in this country, including hypoallergenic ones, and they all
caused our son eczema. We could easily have assumed our son was
allergic to milk, but that didn’t make sense either, because he was
more allergic to yogurt than plain milk — if the problem had been the
protein, it should have been the other way around. Yogurt is a more
equipment-intensive product and probably has more detergents in it —
the yogurt we make ourselves with whole milk from a large local organic
dairy does not cause the eczema. We did find one infant formula from
Europe that did not cause the eczema, but interestingly some of the
other formulations from the same company — with additional ingredients
that require washing — did cause it.

Many food ingredients are washed, opening avenues for surfactants to
end up in the final product. Detergents are used to wash equipment;
small-batch, equipment-intensive-produced foods tend to cause
breakouts. Plastic containers do not have to be washed, but at some
point along the way, metals that become steel cans do. Canned and
jarred foods tend to cause problems, though I am not sure whether it is
because of how the cans and jars themselves are prepared, or because
the contents tend to be wet-processed foods which are generally more of
a problem than dry-processed foods.

Detergents are among the substances
approved for washing produce for canning or freezing, see:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=173.315,
21CFR173.315 Chemicals used in washing or to assist in the peeling of
fruits and vegetables. Remember, tiny traces of detergent can cause
eczema in susceptible children — traces that would easily remain on
food-processing equipment that was regarded as clean. Quaternary
ammonium compounds (detergents) are used in sterilizing some food
processing equipment after it is cleaned.

Although completely removing detergents from diet for any length of
time is a tough step, it is worth doing all the way at least once, just
to let your child experience completely healed, eczema-free skin. Even
if you can’t maintain a detergent-free diet — it is truly tough given
our reliance on packaged and processed foods — it is worth doing at
least once. When your child is completely clear, you can test foods for
detergent reactions the same as you would different food groups on an
elimination diet. It will allow you to see which foods are more of a
problem than others, and allow you to make better judgment calls later,
because it is truly difficult to maintain a completely detergent-free
diet.

Getting completely clear at least once is also worthwhile because it
prepares you for when your child has a major ingestion exposure and
needs to go detergent-free for awhile to eliminate a bad breakout.

Most importantly, it is a huge psychological relief to be able to see
exactly where all the eczema comes from, understand completely how it
works, and to see how much control you have over eliminating it.

The breakouts from ingested detergents can happen immediately or up to
a week after an ingestion. Our pediatric nutritionist told us that four
days was usually as long as one needs to watch, and our experience bore
that out.

Breakouts from ingested detergents last longer than contact rashes —
contact rashes can be eliminated easily with a good washing procedure.
A single ingestion-related breakout can last up to a week even if no
other detergents are ingested.

In our experience, ingestion-related exposures can cause eczema
anywhere, but there are common spots such as the upper arms, legs, back
above the hips, and upper chest. Ingestion-related exposures tend to
break out in the same spots, where the skin was last broken out. Thus,
if the eczema becomes infected, it can be difficult to eliminate the
open spots unless one has the ability to completely eliminate
detergents in the diet for awhile.

To be honest, this is the one area where most people compromise and
live with some eczema. But if all the other steps make a huge
difference in the visible eczema, I would recommend trying to go
detergent-free with foods for at least two or three weeks, taking care
to maintain a balanced diet, of course.

Most food manufacturers don’t even think about detergent
“contaminations” beyond the rinsing measures they use — I’ve talked to
many manufacturers who are so used to thinking of food purity in terms
of preservatives, additives, and commonly allergenic food ingredients,
that they automatically deny their products could have detergents
introduced at any point. I have to usually press people to discuss the
processing of each item in detail to get them to think about the issues
relevant to this allergy.

Often when I explain this allergy to people, they ask if using organic
foods solves the problem. Like the manufacturers themselves, they
confuse food purity vis-à-vis pesticides with absence of detergents. We
do use organic foods for a few reasons. For one, pesticides may be
sprayed using surfactants for even coverage. Non-organic foods may be
subjected to other processing steps that introduce detergents, for
example, one local grocery promises the food is guaranteed washed free
of pesticides. Lastly, when one has to make so much food from basic
ingredients, it’s better to start with good quality ingredients, and at
least where we live, the organic food is usually better.

However, “organic” should not be confused with “detergent-free” in
regards to processing. Organic food processors have to comply with FDA
food processing regulations, and that means washing equipment and raw
produce. Do organic standards allow detergents? I can’t say for sure,
but based on the requirements and personal experience, I don’t see how
they could avoid it. Exceptions are allowable in the CFR and seem to be made for cleaning with synthesized products,
since alternatives are not available, although interestingly, the CFR on organic practices currently mentions only the word "soap" and not "detergent" or "surfactant" for cleaning. (More probably they do not define the term with as much specificity, but I have written to ask.) Organic makers are often smaller,
and smaller batch processing has the potential for introducing greater
amounts of detergents. We’ve had the best luck getting detergent-free
processed foods that are made in very large, high-tech facilities, but
it is no guarantee.

I am currently trying to find a contact in the FDA who can help me
navigate the food processing industry to better identify processed
foods my son can tolerate. As with so many aspects to this problem, I
am still investigating.

The best advice I can give for now is to cook as many things from basic
ingredients as possible, avoiding canned, jarred, and frozen foods. In
our experience, baked goods with simple ingredients from large bakeries
have been the most benign. We’ve had good luck with organic maple syrup
packed in plastic containers, mustard packed in plastic, spices, egg
yolks, some pastas (we tend to buy brown rice pastas, though, I do not
know whether wheat pastas would be processed differently), whole milk
packed in cartons and plastic from a large, local organic dairy. (The
dairy chemist told me that low-fat milk is a more processed product —
not only is the fat removed, but processed protein is added back to the
final product. She said whole milk was probably a better bet for us.)

Foods we’ve had problems with: processed sugar (even brown sugar and
ostensibly less-processed crystallized sugars), poultry, egg whites,
bananas, ketchup, anything packed in recycled glass, have all been
problematic. It’s always possible our son is allergic to those things,
but anytime we’ve been able to test that by being absolutely certain no
detergents are introduced, he has not had problems. When we’ve made
ketchup with homemade concentrated pear sweetener rather than processed
sugar, and basic ingredients identical to our store-bought ketchup, our
son had no eczema from it, but he’s had a mild reaction to every brand
of processed ketchup we’ve tried. Acidic and fatty processed foods seem
to be particularly susceptible to collecting detergent residues.

Step 8: Maintain a detergent-free home even
when skin heals and seems stronger and less susceptible to breakouts

As children grow older, their skin becomes naturally less permeable and
one would expect them to exhibit less eczema after infancy. The skin of
children with detergent-reactive eczema will seem far stronger and
healthier in a safe home environment where their skin is not subject to
persistent breakouts. Even when children seem less susceptible to
eczema breakouts, it is important to maintain these changes.

Maintaining these changes will keep detergents out of dust in the home,
and thus is an important step for mitigating the almost inevitable
development of asthma in children with infantile eczema. (See the
discussion on asthma on this web site.)

It is important for everyone in the home to make this switch in
order to completely eliminate the eczema. To reduce asthma and seasonal
allergies, everyone has to make the switch in order to keep detergents
out of house dust. I cannot stress this enough. When people contact
me after seeing that going detergent-free is making a huge difference
but they still have breakout problems, the number one reason they fail
to eliminate the eczema is that the whole household did not make the
switch. Often, people think they can get away with switching just for
the baby — this is a huge amount of work, and makes too little of a
difference. Other times, there is a holdout in the household, someone
who is just so attached to their personal care products, they figure
one little face wash or moisturizer isn't going to matter (it does).
Often I find that the holdout is an adult with their own history of
eczema or skin problems — people with a history of sensitive skin are
understandably reluctant to change. Many of the happiest success
stories I hear from adults who resolve their skin problems by going
detergent-free come about because they made the switch initially only
for a child but didn't switch the whole household — but when they
finally did switch the whole household, found their own skin problems
resolved, too._top_

Washing products that have worked for us:

Since so many people ask me to make it easy to purchase products in one place, I have set up an Amazon.com astore where all of the products mentioned fit within the SolveEczema.org criteria. (A small portion of sales through that link will go to support this site.) Amazon.com is not necessarily the most optimal place to buy personal care products, but they had the tools to make more things available in one place. http://astore.amazon.com/solvsblogastore-20

There are a few companies that have a large selection of mostly just non-detergent products, I'm sure there are others not listed here (I have usde Cal Ben, Keys Soap and Dr. Bronners products, see below for more information):
Cal Ben www.calbenpuresoap.com
Vermont Soapworks www.vermontsoap.com
Keys Soap www.keys-soap.com
Dr. Bronner's (widely available, at Whole Foods, Country Sun, etc)
Find soap makers at www.soapnaturally.org

Many of the washing products that contain soap on the market today are
combination products that have other vegetable-based surfactants in
them. Many natural products advocates consider vegetable-based products
to be better for the environment than petroleum-based, so these
combination vegetable-based surfactant products can be found on the
shelves of most natural food stores. They aren’t the same as
traditional soap.

While some of these combination products may prove okay for this
allergy — I don’t know — for the purposes of problem-solving, it’s best
to stick with 100% traditional soaps and consider changes once one sees
the results of a total switch.Read labels. Traditional soaps are anionic. In recent years, the
“natural” product sector has been flooded with products containing
nonionic plant-based surfactants. The distinction can usually be found
on the ingredients label. Soaps are called soaps or "saponified" oils; nonionic products
will be separately listed. Other words such as “cleansers”
“surfactants” “liquid laundry cleaner” can be assumed to be something
other than soap. Not all of those ingredients are equivalent to
detergents, but most of them are. Investigate carefully.

To repeat:
It used to be that people differentiated soaps from detergents by the
starting ingredients: soaps came from plant and animal fats, detergents
from petroleum. Surfactant chemistry has allowed companies to produce
surfactants from plant and animal ingredients that could be considered
plant- and animal-based detergents. But for justifiable reasons, makers
continue to label these products as soap, distinguishing the products
by the starting ingredients, rather than by the chemical properties of
the end result.

It’s not clear that soap/nonionic plant-based surfactant combination
products (that are primarily soap) are a problem for this detergent
allergy — maybe they are, maybe they aren’t. My guess is that at least
some of them aren’t, depending on how they are formulated. If they
aren’t, it’s probably for the same reason that the old unscented Dove
was not, but again, I am still answering questions. (I use one that
isn’t a problem, but it is predominantly soap and the nonionic
ingredient is a very minor component.) I would personally avoid
products that are made up only of nonionic surfactants at this
juncture, even from “natural” ingredients, I would not expect them to
be benign with this allergy.
For laundry soap:As is clear from all the email I’ve received from people wanting to
know where to get soap products, it isn’t that easy to get pure soap
products anymore. The soap makers are out there, though. Doing an
advanced Google search for the phrase “soap flakes” turns up numerous
sources. Soap flakes are still more commonly used in some other
countries — I noticed in some cases they ship overseas. Pay attention
to whether the soap flake product can be used in machines, though, some
are only made for hand washing and specifically say not to use them in
machines. |

Pure soap would probably benefit from being combined with washing soda
and/or borax. Some of the soap flake sellers give formulas for making
these combinations at home.

I recently received email from a mom who cleared up her baby’s eczema
using soap products from Vermont Soapworks, www.vermontsoap.com. From my reading of
their site, I would guess that the founder of the company has this
detergent-reactive eczema; the company appears to make all true soap
products made from organic ingredients. Their company rep told me that
all of their washing products are true soap made through traditional
saponification.

I get a number of products from a soap company called Cal Ben Soap
Company, www.calbenpuresoap.com, (800) 340-7091. The company that made
White King, which used to be sold in grocery stores, recommended Cal
Ben when they ceased selling soap flakes. I have had good luck with Cal
Ben’s laundry soap powder, lotionized liquid dish soap (both for dishes and surfaces), automatic
dishwasher powder, and shampoo.

For the purposes of making the initial switch to soaps, I would not
recommend their liquid laundry product for the above reasons, but it
may be okay. I have not tried it. I find their bar soap to be a bit
drying, but not more than Ivory bars, and they’re less drying in my
experience than Dr. Bronner’s and other castile soap products I’ve
tried. (Except for Dr. Bronner's Baby Mild Unscented bar soap, which is
one of the better bar soaps I've tried.) I know many people are
very happy with Dr. Bronner’s and other
castile soaps, my experience is probably individual.

Dri-Pak www.dripak.co.uk made Lux soap flakes, which I understand
Unilever stopped selling last year. I thought Lux was still sold in
Australia, but that could be wrong. Dri-Pak distributes its soap flakes
products in the United States by mail order through MSO Distributing info@msodistributing.com
1.888.508.3496. They sell soap flakes and washing soda. These are the
same formula as Lux flakes without the fragrance.

We washed our son’s hair initially with unscented Dove and later also
with Cal Ben’s shampoo, but as I wrote in our letter, his face didn’t
clear up until we began washing our own hair in soap-based shampoo. We
use Cal Ben’s. Burt’s Bees makes a bar soap shampoo that is probably
safe. Vermont Soapworks makes bar and liquid products that will
probably work. Having soft water makes a big difference with soap-based
shampoo. One mom whose baby had numerous other allergies told me about
the Sun Gold Soap Company. Their products are all fragrance free vegan
soaps. They have bar soap, liquid shampoo, liquid hand/body soap, and
liquid laundry soap. (Note: see updates about unscented Dove on my
blog, http://www.solveeczema.org/eczemablog.
I no longer recommend Dove.)

Inexpensive home recipes: Although Ivory Snow for the laundry is a
detergent product now, as far as I know, the soap bars are still soap.
Recently a mom who cleared her teenager’s skin problems by switching to
soap gave me some recipes for making laundry liquid and powder with
grated soap bars. I have known other people who did this in the past
with success.

There are links below to laundry and dishwasher product recipes.
Permission to reprint the recipes has graciously been granted by
Recipezaar.com www.recipezaar.com
. Important side note: if you search for these recipes on
Recipezaar.com, they come up only under the search word “detergent” and
are called “detergent” recipes, even though they are all recipes for
non-detergent cleaners.

I have used a brand called
Sodasan years ago, which I understand from emailing the company is all organic
and traditional soap-based. I have a concern about one ingredient in
the liquid products, only because I haven’t fully checked it out, but
all of Sodasan’s dry products are soap-based or non-detergent. Sodasan
makes a chemical softener from zeolite which in my experience is the
most gentle and effective chemical softener. Sodasan’s laundry powder
is an interesting switch — it says “detergent” on the front even though
in the ingredients, it lists true soap, a chemical softener, and
washing soda only. I have checked with the company, their product is
indeed soap based. Again, ignore the front labels of all washing
products, they mean nothing. Sodasan is available on Amazon.com.

Ecover and Seventh Generation are heavily marketed as natural products
— and I think they are good products — but for the purposes of this
sensitivity, most of their products are detergents or combination
products. One woman I helped got some email from one of the companies
classifying a combination product as a soap product; this is a
legitimate distinction because of how soaps and detergents have
traditionally been differentiated by their starting ingredients, but it
is not a helpful distinction for the purposes of implementing this
solution. Be very specific if you make inquiries; be sure that the
product is based on traditional anionic soaps. Other types of water
conditioners and degreasers, such as baking powder or Borax, are okay.
I did not see any soap-only products on either Ecover’s or Seventh
Generation’s web sites, but I stand to be corrected. I did see some
products, such as the Ecover dishwasher powder, that MAY prove to be
okay, but again, I recommend first switching only to all-soap or all-nondetergent products,
then experimenting later if you have cleared up all the eczema. I tried
an Ecover laundry liquid without success (my son’s skin turned red),
and the same thing happened to another woman whose son turned out to
have this allergy. At that stage, I did not know about the need for
superwashing and do not know how much that played into the reactions.

I
used to recommend Burt's Bees. They still have many bar soap
products, but their shampoos have been evolving and not necessarily in
a way that works for the recommendations here. Their shampoo and
liquid washing products seem now to be mostly sugar-detergent
based. It's hard to know where these products fit on the
spectrum, I am keeping them on my radar, but for now, I can't recommend
them in the problem-solving phase.

One friend suggested I look into Shaklee’s non-detergent line. I called
and sent Shaklee some email for further information about whether any
of their “non-detergent” products could be considered soaps, but have
not yet received an answer.

I have recently found a company called Ballard Organics, which appears
to make all organic soap products, including an unscented line.
Their products would be considered soap for the purposes of this site.

Non-detergent dishwasher powder products are not soap products — I'm
told that soaps are not a good ingredient for dishwashers. Be certain
the dishwasher powder you choose does not contain detergents of any
kind, but the other mineral and degreaser ingredients should be fine.
See below for links to simple recipes for homemade dishwasher powder.

If you see the word “detergent” anywhere on the label of the
product you are investigating, you do not need to check further. It is
not a soap. (Except for Sodasan’s laundry powder — see above.)

Completely disregard the word “soap” on the front label of all
products; the word is used liberally for all kinds of detergent
products on the front label — especially dishwashing liquids and hand
“soaps” that are really 100% detergents — the information about the
chemical content should be more specific on the ingredients list.

Do not assume that this is any different for “hypoallergenic”,
“natural” or “organic” products — most that I have seen in the health
food store in recent years are all-detergent-based. Some of the makers
who USED to sell soap products now sell plant-based detergents. Some of
these products are appropriately labeled as detergents products, some
are called “non-detergent” products, and some are called soap products
whether they contain traditional soaps or not. Check ingredients.
Sodium lauryl sulfate and sodium laureth sulfate are detergents
commonly found even in “natural” products.

Pure glycerin soap is probably okay, but be careful of possible added
detergent ingredients. Ordinary glycerin has not caused my son problems.

Soapmaking is a popular hobby — there are many sites on the internet
devoted to soapmaking, which include links to suppliers of true soap
ingredients. Most farmers' markets in my area have wonderful true
handmade soaps from small farmers and artisans.

Watch out for nut oil ingredients and other common, potentially
allergenic additives in soap products. Some research suggests that
potentially allergic children should not have nut oils even rubbed on
their skin because it increases their risk of developing anaphylactic
nut allergies. The same may be true of milk, I don’t know.

Cal Ben Soap Company sells a book by Debra Lynn Dadd called Nontoxic,
Natural, & Earthwise. While I am not endorsing any particular
perspective from the book, it is worth taking a look for the lists of
soap makers. Unfortunately, the book was published in 1990 and gives
mainly addresses and telephone numbers, not web sites. Also
unfortunately, many of the makers she recommends have in the interim
switched from selling true soap products to selling plant-based
detergent products or combination products. However, the book is also
useful for general cleaning advice with non-detergent products such as
borax, vinegar, etc.

Again, because of the developments in plant-based surfactants in recent
years, determining that any given product contains traditional soap
rather than detergent surfactants can be a big investigation in itself.
If you find any products that you are able to determine are soap (with
absolute certainty), please send me a link (and any information you
were able to find) so that I may add it to my list!

I have purposely not listed emollient-type moisturizers. They are
probably the longest, most complex discussion of all, and I cannot
write about them at this time. The issues tie in with membrane
permeability, why certain products cause this problem, and how
combinations of different chemicals could change the properties of
certain components. The short answer is: once you get rid of all the
detergents and detergent dust in your home, and if your child’s skin
clears up, you can probably safely use some emollient-type
moisturizers. Which ones is an advanced discussion that stretches the
boundaries of what I know about this problem and relevant chemistry.
Assuming you are pretty sure your child has this detergent allergy — at
least until the eczema is cleared up — I would recommend sticking with
the barrier-type moisturizers, and using them only after washing
detergent residues from the skin for best results. _top_

Below is a list of products;

I listed first the ones I have used. I have listed some products I have
not used, but that I would be comfortable based on the ingredients to
try. Some have been recommended by other people I have helped whose
children have this problem. Remember that you are looking to eliminate
detergents, but that you also have to be aware of individual
sensitivities to ingredients. For more updates, please refer to my
blog www.solveeczema.org/eczemablog
. I try to be very clear about how people can find their own
products locally that work for them.

For a hand-picked store to find many of the products listed below, see the Amazon.com astore I set up (Note: Amazon will be ending its atore program in October, 2017. Using the direct links inserted below instead will continue to provide small but much appreciated support.):http://astore.amazon.com/solvsblogastore-20

Also for the laundry (water conditioners and boosters, other products):Borax (Note: some site users have expressed concerns about borax, please see EWG.org to read more - I use it, but mostly for socks because there is nothing like it to remove odors, and wash it out with soap. It is an effective chemical water softener.)Oxo-briteBaking Soda (Costo sells it in huge bags for laundry)
Sodasan zeolite softenerOxy-Boost from Natural Choices (Be very careful not to accidentally buy another "Oxy" product, many are detergents. In my opinion, this is the best oxygen bleach product on the market and is fabric safe.)
Other oxygen-based bleach products, so long as there are no surfactants
added
Country Save non-chlorine bleach (not their laundry detergent, just the
non-chlorine "bleach" productArm & Hammer Washing SodaBorax and washing soda pack White vinegar (see caveats in previous section, do not combine with other laundry boosters - most brands are similar, often sold in bulk - great household cleaner)

Dish soap

Dishwasher powder

Cal Ben Destain automatic dishwasher powder (get this directly from calbenpuresoap.com, it's too expensive on Amazon)
Sodasan automatic dishwashing powder (I can't find this in the US anymore)
Dishwashing powder recipes [find on web, usually involve citric acid - be sure to get citric acid only from citrus sources, which takes some work to find since sellers all seem to want to present products as if they are, many are not]
I’ve seen other non-detergent dishwasher products – I’m afraid I don’t
have a name offhand — they do not have to be soaps (in fact, I don’t
think you want soaps in your dishwasher), but be careful to avoid the
detergent-like surfactants.

Water Wipes
CleanWell(have small amts of sugar surfactants in them, but they seem to be pretty benign and have been used successfully for kids with this problem, however, I would not use it for face cleaning, just handwipes)PDI sterile saline wipes (expensive but great to have on hand just in case for wiping eyes, faces, noses, very sensitive tissues, especially skinned knees, they clean and seem to take away the "ouch", or used as a handwipe in a pinch.)

Some Opinions About “Normal” Allergy

I include these opinions about allergy as something to think about,
because I could not have solved our son’s eczema save for this
perspective. These are only my theories and opinions, and I reserve the
right to be wrong! However, I find this perspective much more
compatible with all the research coming out ostensibly in support of
the hygiene hypothesis. It certainly better explains the reasons for
the rise in eczema and allergy.

More importantly, I think this perspective is far more helpful from a
problem solving perspective in regards to allergy. When one does not
have a satisfactory solution to a problem, and that solution eludes for
decades, it is reasonable to question whether it is because the problem
is inherently so difficult, or because we are taking the wrong
approach.

It is my opinion that ordinary allergies (non-life-threatening) are a
protective mechanism, the immune system’s way of communicating with the
conscious brain, the way the nervous system communicates through pain.

“Ordinary” allergens have been shown to be similar (but not identical)
to pathogens. The accepted interpretation of this in medicine is that
the immune system is defective in some people and becomes confused. I
believe that the immune system is not confused, but requires greater
energy to differentiate — which is a potential danger to survival in
the long-term — and asks us to remove ourselves from the problem in a
way that creates some urgency but gives us a choice in the short-term.

If the allergen is airborne, we have respiratory symptoms which cease
when we remove ourselves from the problem. If the allergen is contact
related, the symptoms are skin rash, etc. The symptoms are
uncomfortable, but not life-threatening, so we are given time and the
choice to remove ourselves from the source. Over the long term, the
toll on the immune system from expending the extra energy could be a
more serious problem that the immune system is not able to clean up. In
this way, allergic symptoms are a protective mechanism, not
pathological. They usually do no lasting harm if the conscious brain
heeds the warning.

Not everyone reacts or reacts the same, because circumstances (internal
and external) differ. Allergies can come and go throughout life, again,
depending on circumstances. I believe known circumstances in which
allergies develop — such as in bottlefed babies more than
breastmilk-with-its-antibodies-fed babies — are consistent with this
perspective.

There are any number of research examples demonstrating how compromised
or overloaded immunity can go hand-in-hand with allergy — meaning, the
body asks the conscious brain to free up finite energy resources so
that it can do important work.

Until about 80 years ago — an infinitesimal blip in the timeline of
human existence — these messages from the body would have been
relatively easy to heed. Since World War II, we’ve added so many new
kinds of chemicals without the ability to evaluate them fully before
covering the planet with them, while at the same time producing more
and more ways to suppress the body’s natural reaction to them.

[SORRY, I'VE ABANDONED WRITING THIS SECTION FOR THE SITE, BUT NOT DEVELOPING THE HYPOTHESIS.]